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The Case-Case-Control Study Design: Addressing the Limitations of Risk Factor Studies for Antimicrobial Resistance

Published online by Cambridge University Press:  21 June 2016

Keith S. Kaye ,
Anthony D. Harris ,
Matthew Samore  and
Yehuda Carmeli
Keith S. Kaye*
Affiliation:
Department of Medicine, Duke University Medical Center, Durham, North Carolina
Anthony D. Harris
Affiliation:
University of Maryland School of Medicine, College Park, and the Veterans Affairs Maryland Health Care System, Baltimore, Maryland
Matthew Samore
Affiliation:
University of Utah, Salt Lake City, Utah
Yehuda Carmeli
Affiliation:
Tel Aviv Medical Center, Tel Aviv, Israel
*
Box 3152, Durham, NC 27710kaye0001@mc.duke.edu
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Abstract

Objective:

There are significant limitations of the standard case-control study design for identifying risk factors for resistant organisms. The objective of this study was to develop a study design to overcome these limitations.

Design:

Theoretical analysis of different types of study designs that can be used in risk factor studies for resistant organisms.

Results:

We developed the case-case-control study design, which uses two separate case-control analyses within a single study. The first analysis compares patients infected with resistant bacteria (resistant cases) with control-patients without infection caused by the target organism, who are therefore representative of the source population; and the second analysis compares patients infected with the susceptible phenotype of the target organism (susceptible cases) with the same controlpatients without infection caused by the target organism. These two analyses provide risk models for (1) isolation of the resistant phenotype of the target organism as compared with the source population and (2) isolation of the susceptible phenotype of the organism as compared with the source population. When these two risk models are compared and contrasted, risk factors specifically associated with isolation of the resistant phenotype can be identified.

Conclusions:

The case-case-control study design is an effective method for identifying risk factors for antimicrobial-resistant pathogens. Although the case-case-control study design has limitations, it is, in our opinion, more informative and less flawed than the standard case-control study design.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 4 , April 2005 , pp. 346 - 351
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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