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Phase I of Project ICARE was a pilot study to evaluate the relationship between antimicrobial use and resistance in intensive-care unit (ICU) and non-ICU inpatient areas. As part of the study, clinical isolates were submitted by the participating hospital laboratories for validation of antimicrobial susceptibility test results and molecular characterization studies.

See table below for more information.

Study Period	1995
Number of Participants	8 hospitals participating in the National Nosocomial Infections Surveillance (NNIS) System [Learn more]
Study Objectives	Describe the prevalence of antimicrobial resistance and antimicrobial use in 8 U.S. hospitals. Evaluate the relationship between antimicrobial use and resistance in hospitals, with a focus on intensive-care units (ICU). Validate the antimicrobial susceptibility testing of participating laboratories and characterize the isolates submitted.
Methodology	Epidemiology: Participating hospitals collected monthly aggregate antimicrobial usage and antimicrobial resistance data for ICU, non-ICU inpatient, and outpatient areas. Data were collected for specific antimicrobial agents (usage) and specific antimicrobial-organism combinations (resistance). Data were analyzed at CDC using defined daily doses, antimicrobial-use density, and percentage resistance for different antimicrobial-organism combinations. Laboratory: Participating hospital laboratories collected certain bacteria selected for clinical relevance and sent the isolates and their antimicrobial susceptibility test results to CDC. Isolates were frozen and tested at CDC using the NCCLS broth microdilution reference method. Molecular characterization and typing of isolates was performed at CDC and at the Project ICARE Central Laboratory.
Epidemiology Projects	Most antimicrobial resistance was focused in the ICUs of the hospitals. Antimicrobial use varied significantly from hospital to hospital. More data were necessary to determine the role of variables other than antimicrobial use in a statistical model for predicting antimicrobial resistance. Antimicrobial resistance in isolates from inpatient and outpatient in the United States: the increasing importance of the intensive care unit. [Abstract]. Antimicrobial use and resistance in eight US hospitals: complexities of analysis and modeling. [Abstract]
Laboratory Projects	gyrA mutations associated with fluorquinolone resistance in eight species of Enterobacteriaceae [Abstract] Comparison of agar dilution, disk diffusion, MicroScan, and Vitek antimicrobial susceptibility testing methods to broth microdilution for detection of fluoroquinolone-resistant isolates of the Family Enterobacteriaceae [Abstract]
Focus for Isolate Collection (1996-1997)	Klebsiella pneumoniae with decreased susceptibility to ceftazidime. Enterobacteriaceae with decreased susceptibility to fluoroquinolones or carbapenems. Enterococcus species with decreased susceptibility to vancomycin.
Funding Sources	Unrestricted research grants to the Rollins School of Public Health of Emory University from: AstraZeneca Pharmaceuticals, Wilmington, DE National Foundation for Infectious Diseases, Bethesda, MD
Additional Notes	Each participating hospital received financial assistance from Project ICARE to assist with antimicrobial usage and resistance data collection and with the identification, processing, and shipment of the target resistant organisms.