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Lepton

Lepton (1/13)

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  1. Hi....I am working on an assignment to try to understand the volumes of antimicrobial susceptibility testing (AST) in the U.S.. My question revolves around the differences in incidence data (from the CDC) and publicly available antibiogram data from community/academic research hospitals. Let's use Staph. Aureus/MRSA as an example. The CDC states that there are ~70,000 invasive MRSA infections in the U.S. (http://www.cdc.gov/mrsa/tracking/). Additionally, it is estimated that MRSA comprises 50-60% of all SA infections (http://www.biomedcentral.com/1471-2334/14/363); thus, if you have ~70,000 invasive MRSA cases, you also have an additional ~60,000 SA infections, leading to a total of ~130,000 invasive MRSA/SA infections in the U.S. My initial thought is that this represents the market opportunity, in terms of volume of tests, for AST testing. However, I tried to triangulate this volume to the number of SA/MRSA isolates listed on hospital antibiograms, and I find that my initial estimate is much lower than the number of SA/MRSA isolates tested in hospital labs. For example, the Duke University Medical Center Microbiology Lab had 3052 SA/MRSA isolates in 2012 (http://clinlabs.duke.edu/DukeMicrobiology/Antibiogram.aspx); likewise, the Univ. of Washington/Harborview Medical Center 2013 antibiogram showed 3814 SA/MRSA isolates in 2012 (http://hsl.uw.edu/files/antibiograms/uw-medicine-gpc-2012-antibiogram/view). Thus, these medical centers account for ~5% of my initial SA/MRSA estimate, which is way too high. If you scaled up the number of isolates from these centers to account for all acute care beds in the U.S., you end up with something in the 2 - 4 M SA/MRSA isolates range. So, can someone please help explain this discrepancy? Are my assumptions off? Do antibiograms include surveillance cultures in addition to clinical cultures? Are multiple isolates tested for each patient/specimen? Are a large number of non-invasive infections being cultured? I would appreciate any insights someone can offer. Thanks!
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