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Relationship Between Population Density of Attorneys and Prevalence of Methicillin-Resistant Staphylococcus aureus: Is Medical-Legal Pressure on Physicians a Driving Force Behind the Development of Antibiotic Resistance?

Sakoulas, George MD1; Wormser, Gary P MD1; Visintainer, Paul PhD2; Aronow, Wilbert S MD3*; Nadelman, Robert B MD1

doi: 10.1097/MJT.0b013e3181727946
Original Article

We performed a hypothesis-generating study evaluating the perceived threat of lawsuits among physicians and methicillin resistance in Staphylococcus aureus. We found a correlation between the prevalence of methicillin resistance among clinical S. aureus isolates and both antibiotic prescriptions per capita and density of attorneys in countries in Europe and North America. We did not find a correlation between prevalence of methicillin resistance and physician density. Further investigation is warranted to study whether physicians' perceived fear of lawsuits, of which attorney density may be a crude surrogate marker, results in antibiotic prescription practices that contribute to the emergence of antimicrobial resistance among virulent pathogens such as S. aureus, with global implications on the ethics of the delivery of quality health care to all members of society.

1Division of Infectious Diseases, Department of Medicine; 2Department of Epidemiology and Biostatistics, School of Public Health; and 3Division of Cardiology, Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595.

*Address for correspondence: Division of Cardiology, Department of Medicine, New York Medical College and Westchester Medical Center, Macy Pavilion, Room 138, Valhalla, NY 10595. E-mail: wsaronow@aol.com

© 2009 Lippincott Williams & Wilkins, Inc.