Investigating potential spatiotemporal co-occurrence of multi-drug resistant Staphylococcus aureus in the United States, 2010-2019

Keywords: bacteria, antibiotic resistance, cluster, United States
Abstract Type: Paper Abstract

Abstract

The increase in bacterial resistance to multiple classes of antibiotics limits effective treatment options. Understanding how co-occurrence of resistance varies in space and time is important for informing empiric therapy, the prescribing of antimicrobials before lab-based susceptibility testing results are available to the provider. Utilizing a dataset of 383,514 Staphylococcus aureus isolates obtained in outpatient settings in the Veterans Health Administration from 2010-2019, we explored spatiotemporal variation in resistance to three major classes of antibiotics (clindamycin, tetracycline, sulfamethoxazole/trimethoprim). Increased prevalence of tetracycline resistance, from 3.9% to 13.1%, and sulfamethoxazole/trimethoprim resistance, from 2.7% to 9.3%, was observed, while clindamycin resistance remained steady at 2.4-3.1%. However, resistance to tetracycline and trimethoprim/sulfamethoxazole did not co-occur in either space or time, indicating that they remain clinically relevant but that their utilization should be dependent on the spatial location of the infected patient. Examining the spatial variation in antibiotic resistance can lead to tailoring of empiric therapy based upon local context rather than national trends.