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Larrosa MN, Canut-Blasco A, Benito N, Cantón R, Cercenado E, Docobo-Pérez F, Fernández-Cuenca F, Fernández-Domínguez J, Guinea J, López-Navas A, Moreno MÁ, Morosini MI, Navarro F, Martínez-Martínez L, Oliver A. Spanish Antibiogram Committee (COESANT) recommendations for cumulative antibiogram reports. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022:S2529-993X(22)00177-0. [PMID: 36175285 DOI: 10.1016/j.eimce.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/31/2021] [Accepted: 01/13/2022] [Indexed: 06/16/2023]
Abstract
The Spanish Antibiogram Committee (Comité Español del Antibiograma, COESANT) presents in this document a series of recommendations intending to unify how cumulative antibiogram reports must be made in Clinical Microbiology Spanish laboratories. This article is based on the information included in the Clinical Microbiology Procedure No. 51, «Preparation of cumulative reports on antimicrobial susceptibility» of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), published in 2014. The recommendations also include the modifications in the definition of clinical interpretive categories recently published by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2019. Its final objective is to establish a homogeneous way of preparing these summaries to compare results from different centers or aggregate the information from these in order to carry out an adequate local or even national surveillance regarding the evolution of antimicrobial susceptibility.
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Affiliation(s)
- María Nieves Larrosa
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
| | | | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Rafael Cantón
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Docobo-Pérez
- Departamento de Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Felipe Fernández-Cuenca
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; UGC Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Javier Fernández-Domínguez
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología, Hospital Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Jesús Guinea
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio López-Navas
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Miguel Ángel Moreno
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | - Mª Isabel Morosini
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ferran Navarro
- Servicio de Microbiología, Hospital de la Santa Creu i Sant Pau, Departamento de Genética y de Microbiología de la Universitat Autònoma de Barcelona, Institut d'Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Luis Martínez-Martínez
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Unidad de Gestión Clínica de Microbiología, Hospital Reina Sofía, Departamento de Química Agrícola, Edafología y Microbiología, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Antonio Oliver
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain; Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain
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Recomendaciones del Comité Español del Antibiograma (COESANT) para la realización de los Informes de Sensibilidad Antibiótica Acumulada. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Iyori K, Shishikura T, Shimoike K, Minoshima K, Imanishi I, Toyoda Y. Influence of hospital size on antimicrobial resistance and advantages of restricting antimicrobial use based on cumulative antibiograms in dogs with Staphylococcus pseudintermedius infections in Japan. Vet Dermatol 2021; 32:668-e178. [PMID: 34009720 PMCID: PMC9290958 DOI: 10.1111/vde.12975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Abstract
Background Antimicrobial resistance in Staphylococcuspseudintermedius (SP) and the prevalence of meticillin‐resistant SP (MRSP) is increasing in dogs worldwide. Objectives To evaluate the influence of hospital size on antimicrobial resistance of SP and whether restricted use of antimicrobials based on antibiograms could reduce the identification of antimicrobial resistance in SP from infected dogs. Methods and materials In Study 1, a total of 2,294 SP isolates from dogs with pyoderma (n = 1,858, 52 hospitals) or otitis externa (OE; n = 436, 44 hospitals) taken between 2017 and 2019 were analysed. Clinics were categorised into small, medium and large based on numbers of practicing veterinary surgeons. In Study 2, a cumulative antibiogram was constructed for 12 antimicrobials from one large veterinary clinic from 2017 to 2018. Referring to this antibiogram, the clinic introduced strict antimicrobial selection criteria to treat dogs with pyoderma and OE, starting in 2018. Results MRSP was identified in 981 dogs (42.8%). In large clinics, the isolation rate of MRSP was 51.1% (404 of 791), which was significantly higher (P < 0.01) than in small clinics with less than two veterinary practitioners (34.0%, 154 of 453). In the antibiogram study, the susceptibility rates of oxacillin (MPIPC, 61.5%), cefpodoxime (CPDX, 55.8%) and minocycline (MINO, 55.8%) were significantly higher in 2019 (n = 52) than in 2017 to 2018 (n = 54; MPIPC, 37.0%; CPDX, 33.3%; MINO, 20.4%; P < 0.05). Conclusions and clinical relevance Hospital size could affect the isolation rate of MRSP in dogs. Restricted use of antimicrobials for over a year based on cumulative antibiograms could reduce the resistance rate of multiple antimicrobials in SP isolated from dogs with pyoderma and OE. Background – Antimicrobial resistance in Staphylococcuspseudintermedius (SP) and the prevalence of meticillin‐resistant SP (MRSP) is increasing in dogs worldwide. Objectives: To evaluate the influence of hospital size on antimicrobial resistance of SP and whether restricted use of antimicrobials based on antibiograms could reduce the identification of antimicrobial resistance in SP from infected dogs. Conclusions and clinical relevance – Hospital size could affect the isolation rate of MRSP in dogs. Restricted use of antimicrobials for over a year based on cumulative antibiograms could reduce the resistance rate of multiple antimicrobials in SP isolated from dogs with pyoderma and OE.
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Affiliation(s)
- Keita Iyori
- Vet Derm Tokyo, Dermatological and Laboratory Service for animals, 910 Shoubusawa, Fujisawa-shi, Kanagawa, 252-0823, Japan
| | - Taku Shishikura
- Daktari Animal Hospital Tokyo Medical Center, 5-14-1 Shirokanedai, Minato-ku, Tokyo, Japan
| | - Kenta Shimoike
- Vet Derm Tokyo, Dermatological and Laboratory Service for animals, 910 Shoubusawa, Fujisawa-shi, Kanagawa, 252-0823, Japan
| | - Kenichi Minoshima
- Vet Derm Tokyo, Dermatological and Laboratory Service for animals, 910 Shoubusawa, Fujisawa-shi, Kanagawa, 252-0823, Japan
| | - Ichiro Imanishi
- Department of Microbiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yoichi Toyoda
- Vet Derm Tokyo, Dermatological and Laboratory Service for animals, 910 Shoubusawa, Fujisawa-shi, Kanagawa, 252-0823, Japan
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Miller JL, George A, Kozmic SE, Beganovic M, Wieczorkiewicz SM. Comparison of emergency department to hospital antibiograms: Influence of patient risk factors on susceptibility. Am J Emerg Med 2020; 38:1153-1158. [DOI: 10.1016/j.ajem.2019.158403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022] Open
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Denisuik AJ, Garbutt LA, Golden AR, Adam HJ, Baxter M, Nichol KA, Lagacé-Wiens P, Walkty AJ, Karlowsky JA, Hoban DJ, Mulvey MR, Zhanel GG. Antimicrobial-resistant pathogens in Canadian ICUs: results of the CANWARD 2007 to 2016 study. J Antimicrob Chemother 2020; 74:645-653. [PMID: 30500898 DOI: 10.1093/jac/dky477] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/12/2018] [Accepted: 10/23/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To describe the microbiology and antimicrobial resistance patterns of cultured samples acquired from Canadian ICUs. METHODS From 2007 to 2016, tertiary care centres from across Canada submitted 42938 bacterial/fungal isolates as part of the CANWARD surveillance study. Of these, 8130 (18.9%) were from patients on ICUs. Susceptibility testing guidelines and MIC interpretive criteria were defined by CLSI. RESULTS Of the 8130 pathogens collected in this study, 58.2%, 36.3%, 3.1% and 2.4% were from respiratory, blood, wound and urine specimens, respectively. The top five organisms collected from Canadian ICUs accounted for 55.4% of all isolates and included Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (10.6%), Escherichia coli (10.4%), Streptococcus pneumoniae (6.5%) and Klebsiella pneumoniae (6.4%). MRSA accounted for 20.7% of S. aureus collected, with community-associated (CA) MRSA genotypes increasing in prevalence over time (P < 0.001). The highest susceptibility rates among MRSA were 100% for vancomycin, 100% for ceftobiprole, 100% for linezolid, 99.7% for ceftaroline, 99.7% for daptomycin and 99.7% for tigecycline. The highest susceptibility rates among E. coli were 100% for tigecycline, 99.9% for meropenem, 99.7% for colistin and 94.2% for piperacillin/tazobactam. MDR was identified in 26.3% of E. coli isolates, with 10.1% producing an ESBL. The highest susceptibility rates among P. aeruginosa were 97.5% for ceftolozane/tazobactam, 96.1% for amikacin, 94.7% for colistin and 93.3% for tobramycin. CONCLUSIONS The most active agents against Gram-negative bacilli were the carbapenems, tigecycline and piperacillin/tazobactam. Against Gram-positive cocci, the most active agents were vancomycin, daptomycin and linezolid. The prevalence of CA-MRSA genotypes and ESBL-producing E. coli collected from ICUs increased significantly over time.
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Affiliation(s)
- Andrew J Denisuik
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lauren A Garbutt
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alyssa R Golden
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Adam
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinical Microbiology, Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - Melanie Baxter
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kimberly A Nichol
- Clinical Microbiology, Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - Philippe Lagacé-Wiens
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinical Microbiology, Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew J Walkty
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinical Microbiology, Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - James A Karlowsky
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinical Microbiology, Shared Health Manitoba, Winnipeg, Manitoba, Canada
| | - Daryl J Hoban
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael R Mulvey
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- Antimicrobial Resistance Branch, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
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Cusini A, Herren D, Bütikofer L, Plüss-Suard C, Kronenberg A, Marschall J. Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in Escherichia coli and Klebsiella pneumoniae: a retrospective observational study. Antimicrob Resist Infect Control 2018; 7:89. [PMID: 30069305 PMCID: PMC6064170 DOI: 10.1186/s13756-018-0387-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/20/2018] [Indexed: 12/28/2022] Open
Abstract
Background Monitoring antimicrobial use and resistance in hospitals are important tools of antimicrobial stewardship programs. We aimed to determine the association between the use of frequently prescribed antibiotics and the corresponding resistance rates in Escherichia coli and Klebsiella pneumoniae among the clinical departments of a tertiary care hospital. Methods We performed a retrospective observational study to analyse the use of nine frequently prescribed antibiotics and the corresponding antimicrobial resistance rates in hospital acquired E. coli and K. pneumoniae isolates from 18 departments of our institution over 9 years (2008–2016). The main cross-sectional analysis assessed the hypothetical influence of antibiotic consumption on resistance by mixed logistic regression models. Results We found an association between antibiotic use and resistance rates in E. coli for amoxicillin-clavulanic acid (OR per each step of 5 defined daily dose/100 bed-days 1.07, 95% CI 1.02–1.12; p = 0.004), piperacillin-tazobactam (OR 2.11, 95% CI 1.45–3.07; p < 0.001), quinolones (OR 1.52, 95% CI 1.25–1.86; p < 0.001) and trimethoprim-sulfamethoxazole (OR 1.59, 95% CI 1.19–2.13; p = 0.002). Additionally, we found a significant association when all nine antibiotics were combined in one analysis. The association between consumption and resistance rates was stronger for nosocomial than for community strains. In K. pneumoniae, we found an association for amoxicillin-clavulanic acid (OR 1.07, 95% CI 1.01–1.14; p = 0.025) and for trimethoprim-sulfamethoxazole (OR 2.02, 95% CI 1.44–2.84; p < 0.001). The combined analysis did not show an association between consumption and resistance (OR 1.06, 95% CI 0.99–1.14; p = 0.07). Conclusions We documented an association between antibiotic use and resistance rate for amoxicillin-clavulanic acid, piperacillin-tazobactam, quinolones and trimethoprim-sulfamethoxazole in E. coli and for amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole in K. pneumoniae across different hospital departments. Our data will support stewardship interventions to optimize antibiotic prescribing at a department level. Electronic supplementary material The online version of this article (10.1186/s13756-018-0387-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexia Cusini
- 1Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland.,5Infectious Diseases Unit, Cantonal Hospital, 7000 Chur, Switzerland
| | - David Herren
- 1Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Lukas Bütikofer
- 3CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Catherine Plüss-Suard
- 4Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas Kronenberg
- 1Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland.,2Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Jonas Marschall
- 1Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
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Tolg MSA, Dosa DM, Jump RLP, Liappis AP, LaPlante KL. Antimicrobial Stewardship in Long-Term Care Facilities: Approaches to Creating an Antibiogram when Few Bacterial Isolates Are Cultured Annually. J Am Med Dir Assoc 2018; 19:744-747. [PMID: 29934089 DOI: 10.1016/j.jamda.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/09/2018] [Indexed: 12/18/2022]
Abstract
Antibiograms are important clinical tools to report and track antibiotic susceptibility and help guide empiric antimicrobial therapy. Antibiograms support compliance with antimicrobial stewardship (AMS) requirements from the Centers for Medicare and Medicaid Services and are in line with recommendations from the Centers for Disease Control and Prevention Core Elements of AMS for nursing homes/long-term care facilities (LTCFs). Unlike most acute-care settings, LTCFs are challenged in creating antibiograms because of the low number of bacterial isolates collected annually. Determining the best methodology for creating clinically useful antibiograms for LTCFs needs to be explored. Possible approaches include (1) extending the isolate data beyond 1 year, (2) combining isolate data from the same geographic region, (3) using a nearby acute-care facility's antibiogram as a proxy, or (4) collapsing isolate data. This article discusses the benefits and limitations of each approach.
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Affiliation(s)
- Maria-Stephanie A Tolg
- Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI; Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI
| | - David M Dosa
- Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI; Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI; Warren Alpert Medical School of Brown University, Providence, RI
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC) and the Specialty Care Center of Innovation at the Louis Stokes Cleveland, Department of Veterans Affairs Medical Center, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
| | - Angelike P Liappis
- Section of Infectious Diseases, Washington DC Veterans Affairs Medical Center, Washington DC
| | - Kerry L LaPlante
- Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI; Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI; Warren Alpert Medical School of Brown University, Providence, RI.
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Zatorski C, Jordan JA, Cosgrove SE, Zocchi M, May L. Comparison of antibiotic susceptibility of Escherichia coli in urinary isolates from an emergency department with other institutional susceptibility data. Am J Health Syst Pharm 2016; 72:2176-80. [PMID: 26637517 DOI: 10.2146/ajhp140832] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The antibiotic susceptibility of Escherichia coli in isolates from patients with uncomplicated urinary tract infection (UTI) in an emergency department (ED) was compared with susceptibility data from the associated hospital. METHODS Patients eligible for study participation included women age 18-65 years with one or more symptoms consistent with a UTI for whom a urine dipstick, urinalysis, or urine culture was ordered. Clinical decision-making, including the decision to order a urine culture, was at the discretion of the individual healthcare provider; however, a deidentified urine culture and antimicrobial susceptibility testing were performed for those study participants for whom a urine culture was not ordered. We compared the E. coli-specific antibiogram for uncomplicated UTI to the antibiogram based on all urine cultures in the ED regardless of patient disposition, non-intensive care unit (ICU) hospital inpatients, and the hospitalwide antibiogram. RESULTS Of the 578 ED patients screened for study eligibility, 119 met the inclusion criteria. E. coli, detected in 53 (74%) of the 72 pathogen-positive cultures, was the most common pathogen isolated. For E. coli, ciprofloxacin nonsusceptibility was significantly less common in isolates from ED patients with uncomplicated cystitis and pyelonephritis than in isolates from non-ICU inpatients or from the hospitalwide population. E. coli nonsusceptibility to ciprofloxacin was significantly less common in ED isolates from patients with uncomplicated UTI than in isolates from all ED patients with clinician-ordered urine cultures. CONCLUSION Antibiotic susceptibility of E. coli in an ED and its associated hospital depended on factors such as whether patients were hospitalized and whether ED isolates were from patients with uncomplicated UTI.
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Affiliation(s)
- Catherine Zatorski
- Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University
| | - Jeanne A Jordan
- Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University
| | - Sara E Cosgrove
- Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University
| | - Mark Zocchi
- Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University
| | - Larissa May
- Catherine Zatorski, B.A., is Research Coordinator, Departments of Emergency Medicine and Infectious Diseases; and Jeanne A. Jordan, PH.D., is Professor, Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC. Sara E. Cosgrove, M.D., M.S., is Director of Antimicrobial Stewardship and Associate Professor, Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, MD. Mark Zocchi, M.P.H., is Senior Research Associate, Office of Clinical Practice Innovation; and Larissa May, M.D., M.S.P.H., M.S.H.S., is Associate Professor and Associate Director of Clinical Research, Department of Emergency Medicine, George Washington University.
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Solid organ transplant antibiograms: an opportunity for antimicrobial stewardship. Diagn Microbiol Infect Dis 2016; 86:460-463. [PMID: 27733304 DOI: 10.1016/j.diagmicrobio.2016.08.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We aimed to compare the antimicrobial susceptibility percentages in blood and urine bacterial isolates recovered from solid organ transplant (SOT) recipients with those reported in the hospital-wide antibiogram. METHODS Retrospective review of the antimicrobial susceptibilities of bacterial isolates recovered from SOT recipients at a 1550-bed hospital over a 2-year period. Antibiograms were categorized by anatomic site (blood and urine). Percentage of bacterial susceptibilities to specific antibiotics were compared with the hospital-wide antibiogram. RESULTS A total of 1889 unique cultures were identified. Blood and urine isolates of Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa had significantly lower susceptibility to first and second line antibiotics compared to the hospital-wide antibiogram. CONCLUSION Significant differences in susceptibilities between isolates from blood and urine cultures from SOT recipients and the hospital-wide antibiogram were found. A population-based strategy for the development of antibiograms specific for this group of high-risk patients could better guide appropriate empiric antimicrobial selection.
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Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data--The Influence of Different Parameters in a Routine Clinical Microbiology Laboratory. PLoS One 2016; 11:e0147965. [PMID: 26814675 PMCID: PMC4729434 DOI: 10.1371/journal.pone.0147965] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 01/11/2016] [Indexed: 12/04/2022] Open
Abstract
Introduction Many clinical microbiology laboratories report on cumulative antimicrobial susceptibility testing (cAST) data on a regular basis. Criteria for generation of cAST reports, however, are often obscure and inconsistent. Whereas the CLSI has published a guideline for analysis and presentation of cAST data, national guidelines directed at clinical microbiology laboratories are not available in Europe. Thus, we sought to describe the influence of different parameters in the process of cAST data analysis in the setting of a German routine clinical microbiology laboratory during 2 consecutive years. Material and Methods We developed various program scripts to assess the consequences ensuing from different algorithms for calculation of cumulative antibiograms from the data collected in our clinical microbiology laboratory in 2013 and 2014. Results One of the most pronounced effects was caused by exclusion of screening cultures for multi-drug resistant organisms which decreased the MRSA rate in some cases to one third. Dependent on the handling of duplicate isolates, i.e. isolates of the same species recovered from successive cultures on the same patient during the time period analyzed, we recorded differences in resistance rates of up to 5 percentage points for S. aureus, E. coli and K. pneumoniae and up to 10 percentage points for P. aeruginosa. Stratification by site of care and specimen type, testing of antimicrobials selectively on resistant isolates, change of interpretation rules and analysis at genus level instead of species level resulted in further changes of calculated antimicrobial resistance rates. Conclusion The choice of parameters for cAST data analysis may have a substantial influence on calculated antimicrobial resistance rates. Consequently, comparability of cAST reports from different clinical microbiology laboratories may be limited. We suggest that laboratories communicate the strategy used for cAST data analysis as long as national guidelines for standardized cAST data analysis and reporting do not exist in Europe.
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Cumulative Antimicrobial Susceptibility Data from Intensive Care Units at One Institution: Should Data Be Combined? J Clin Microbiol 2016; 54:956-9. [PMID: 26791365 DOI: 10.1128/jcm.02992-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/11/2016] [Indexed: 11/20/2022] Open
Abstract
Cumulative susceptibility test data (CSTD) are used to guide empirical antimicrobial therapy and to track trends in antibiotic resistance. The Clinical and Laboratory Standards Institute recommends reporting CSTD at least annually and sets the minimum number of isolates per reported organism at 30. To comply, many hospitals combine data from multiple intensive care units (ICUs); however, this may not be appropriate to guide empirical therapy because of variations in patient populations. In this study, susceptibility data for two different ICUs at a tertiary care hospital in Toronto, Canada, were used to create a traditional CSTD report, which combined data from different ICUs, and a rolling-average CSTD report, which pooled 2 years of data for each ICU separately. For simplicity, data for only the most common Gram-negative organisms (Escherichia coli,Pseudomonas aeruginosa) and the most relevant antibiotics (ciprofloxacin, piperacillin-tazobactam) were examined. With the rolling-average method, significant differences in susceptibility were seen between the ICUs in 50% of the organism-antimicrobial combinations. Furthermore, the 3% median year-over-year difference in susceptibilities seen for the 16 organism-antibiotic combinations by using the traditional method was lower than the 14% median difference seen for the 20 between-ICU within-year comparisons obtained using the rolling-average method. Changes in our selection of empirical antibiotics resulted from this revised approach, and our results suggest that pooling data from ICUs with different patient populations may not be appropriate. A rolling-average method may be an appropriate strategy for the creation of individual-unit CSTD reports.
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Canut-Blasco A, Calvo J, Rodríguez-Díaz JC, Martínez-Martínez L. [Antimicrobial susceptibility cumulative reports]. Enferm Infecc Microbiol Clin 2015; 34:524-30. [PMID: 25962661 DOI: 10.1016/j.eimc.2015.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022]
Abstract
Cumulative reports on antimicrobial susceptibility tests data are important for selecting empirical treatments, as an educational tool in programs on antimicrobial use, and for establishing breakpoints defining clinical categories. These reports should be based on data validated by clinical microbiologists using diagnostic samples (not surveillance samples). In order to avoid a bias derived from including several isolates obtained from the same patient, it is recommended that, for a defined period, only the first isolate is counted. A minimal number of isolates per species should be presented: a figure of >=30 isolates is statistically acceptable. The report is usually presented in a table format where, for each cell, information on clinically relevant microorganisms-antimicrobial agents is presented. Depending on particular needs, multiple tables showing data related to patients, samples, services or special pathogens can be prepared.
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Affiliation(s)
| | - Jorge Calvo
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, España
| | - Juan Carlos Rodríguez-Díaz
- Servicio de Microbiología, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, España
| | - Luis Martínez-Martínez
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, España; Departamento de Biología Molecular, Universidad de Cantabria, Santander, España.
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Moore LSP, Freeman R, Gilchrist MJ, Gharbi M, Brannigan ET, Donaldson H, Livermore DM, Holmes AH. Homogeneity of antimicrobial policy, yet heterogeneity of antimicrobial resistance: antimicrobial non-susceptibility among 108,717 clinical isolates from primary, secondary and tertiary care patients in London. J Antimicrob Chemother 2014; 69:3409-22. [PMID: 25118270 PMCID: PMC4228780 DOI: 10.1093/jac/dku307] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/26/2014] [Accepted: 07/17/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES We examined the 4 year trend in antimicrobial susceptibilities and prescribing across levels of care at two London teaching hospitals and their multisite renal unit, and for the surrounding community. METHODS Laboratory and pharmacy information management systems were interrogated, with antimicrobial use and susceptibilities analysed between hospitals, within hospitals and over time. RESULTS A total of 108,717 isolates from 71,687 patients were identified, with significant differences (at P < 0.05) in antimicrobial susceptibility between and within hospitals. Across the 4 years, rates of ESBL-/AmpC-producing Enterobacteriaceae ranged from 6.4% to 10.7% among community isolates, 17.8% to 26.9% at ward level and 25.2% to 52.5% in critical care. Significant variations were also demonstrated in glycopeptide-resistant enterococci (ward level 6.2%-17.4%; critical care 21.9%-56.3%), MRSA (ward level 18.5%-38.2%; critical care 12.5%-47.9%) and carbapenem-resistant Pseudomonas spp. (ward level 8.3%-16.9%; critical care 19.9%-53.7%). Few instances of persistently higher resistance were seen between the hospitals in equivalent cohorts, despite persistently higher antimicrobial use in Hospital 1 than Hospital 2. We found significant fluctuations in non-susceptibility year on year across the cohorts, but with few persistent trends. CONCLUSIONS The marked heterogeneity of antimicrobial susceptibilities between hospitals, within hospitals and over time demands detailed, standardized surveillance and appropriate benchmarking to identify possible drivers and effective interventions. Homogeneous antimicrobial policies are unlikely to continue to be suitable as individual hospitals join hospital networks, and policies should be tailored to local resistance rates, at least at the hospital level, and possibly with finer resolution, particularly for critical care.
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Affiliation(s)
- Luke S P Moore
- National Centre for Infection Prevention and Management, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Rachel Freeman
- National Centre for Infection Prevention and Management, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK
| | - Mark J Gilchrist
- National Centre for Infection Prevention and Management, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Myriam Gharbi
- National Centre for Infection Prevention and Management, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK
| | - Eimear T Brannigan
- Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Hugo Donaldson
- Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - David M Livermore
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK Antimicrobial Resistance & Healthcare Associated Infection Reference Unit, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Alison H Holmes
- National Centre for Infection Prevention and Management, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
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Tan R, Liu J, Li M, Huang J, Sun J, Qu H. Epidemiology and antimicrobial resistance among commonly encountered bacteria associated with infections and colonization in intensive care units in a university-affiliated hospital in Shanghai. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:87-94. [PMID: 23357606 DOI: 10.1016/j.jmii.2012.11.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/01/2012] [Accepted: 06/28/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to classify intensive care unit (ICU) bacterial strains as either ICU-acquired or ICU-on-admission and to compare their epidemiological and antibiogram characteristics. METHODS The study was performed in a 1300-bed university-affiliated hospital from January 1, 2006 to December 31, 2010. Based on the time of ICU admission, ICU isolates were classified as ICU-acquired strains (appearing more than 48 hours after admission) or ICU-on-admission strains (appearing 48 hours or less from admission). The microbiological data before ICU admission, the microbiological data, and susceptibility testing were compared between the ICU-acquired and ICU-on-admission bacterial isolates. RESULTS The most common ICU-acquired strains were Acinetobacter baumannii (19.5%), Pseudomonas aeruginosa (15.6%), Stenotrophomonas maltophilia (11.5%), Staphylococcus aureus (10.7%), Enterococcus spp. (10.6%), and Klebsiella pneumoniae (9.7%). There were significant differences between ICU-acquired and ICU-on-admission isolates in the susceptibility rates of Gram-negative bacteria to antibiotics, especially the susceptibility of A. baumannii to imipenem [23.8% (ICU-acquired) vs. 44.4% (ICU-on-admission), p < 0.001] and meropenem (24.1% vs. 37.8%, p < 0.001), and the susceptibility of P. aeruginosa to imipenem (39.3% vs. 76.1%, p < 0.001) and meropenem (58.5% vs. 76.1%, p < 0.05). Furthermore, decreased susceptibility rates of A. baumannii and P. aeruginosa to carbapenems were correlated with an extended ICU stay (p < 0.05). CONCLUSION Because of decreasing susceptibility rates of pathogens (especially ICU-acquired strains) and a significant correlation with the length of ICU stay, intensivists should consider a patient's time of ICU admission and previous microbiological data and should distinguish ICU-acquired strains from non-ICU-acquired strains so as to initiate optimized empirical antibiotic therapy against ICU-acquired infections.
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Affiliation(s)
- Ruoming Tan
- Department of Critical Care Medicine and Respiratory Intensive Care Unit, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China
| | - Jialin Liu
- Department of Critical Care Medicine and Respiratory Intensive Care Unit, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China
| | - Meiling Li
- Department of Critical Care Medicine and Respiratory Intensive Care Unit, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China
| | - Jie Huang
- Department of Critical Care Medicine and Respiratory Intensive Care Unit, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China
| | - Jingyong Sun
- Department of Microbiology, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China
| | - Hongping Qu
- Department of Critical Care Medicine and Respiratory Intensive Care Unit, Shanghai Ruijin Hospital Affiliated with Jiaotong University, Shanghai, China.
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