Development of a Statewide Antibiogram to Assess Regional Trends in Antibiotic-Resistant ESKAPE Organisms

Guarascio, Anthony J.; Brickett, Laura; Porter, Timothy J.; Lee, Nancy D.; Gorse, Erin E.; Covvey, Jordan R.

doi:10.1177/0897190017735425

Cited by 11 publications

(12 citation statements)

References 20 publications

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“…A regional antibiogram can also be an effective tool for regional surveillance of emerging antibiotic resistance in a wide range of organisms and can serve as a benchmark for antibiotic resistance across hospitals and regions, which can affect antibiotic prescribing. 22 -27…”

Section: Discussionmentioning

confidence: 99%

“…Other public health jurisdictions have developed antibiograms or are exploring options and best practices for developing them. 22 -30 To our knowledge, however, New Hampshire is the first state to use a combined antibiogram to proactively promote appropriate antibiotic prescribing through statewide clinical messaging that targets common infectious syndromes.…”

Section: Discussionmentioning

confidence: 99%

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Creation of State Antibiogram and Subsequent Launch of Public Health–Coordinated Antibiotic Stewardship in New Hampshire: Small State, Big Collaboration

Leeman¹,

Chan²,

Zimmermann³

et al. 2021

Public Health Rep

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Background An antibiogram is a summary of antibiotic susceptibility patterns for selected bacterial pathogens and antibiotics. The New Hampshire Department of Health and Human Services’ Division of Public Health Services (DPHS) sought to create an annual state antibiogram to monitor statewide antibiotic resistance trends, guide appropriate empiric antibiotic prescribing, and inform future statewide antibiotic stewardship. Methods Through legislative authority, DPHS required hospital laboratories to report antibiogram data annually. DPHS convened an advisory group of infectious disease and pharmacy stakeholders and experts to develop a standardized reporting form for bacteria and antibiotic susceptibility, which was disseminated to all 26 hospitals in New Hampshire. We combined the reported data into a statewide antibiogram, and we created clinical messaging to highlight findings and promote rational antibiotic prescribing among health care providers. Results All hospital laboratories in New Hampshire submitted annual antibiogram data for 2016 and 2017, including more than 30 000 and 20 000 bacterial isolates recovered from urine and nonurine cultures, respectively, each year. The advisory group created clinical messages for appropriate treatment of common infectious syndromes, including uncomplicated urinary tract infections, community-acquired pneumonia, skin and soft-tissue infections, intra-abdominal infections, and health care–associated gram-negative aerobic infections. The statewide antibiograms and clinical messaging were widely disseminated. Conclusions The small size of New Hampshire, a centralized public health structure, and close working relationships with hospitals and clinical partners allowed for efficient creation and dissemination of an annual statewide antibiogram, which has fostered public health–clinical partnerships and built a foundation for future state-coordinated antibiotic stewardship. This process serves as a model for other jurisdictions that are considering antibiogram development.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Creation of State Antibiogram and Subsequent Launch of Public Health–Coordinated Antibiotic Stewardship in New Hampshire: Small State, Big Collaboration

Leeman¹,

Chan²,

Zimmermann³

et al. 2021

Public Health Rep

View full text Add to dashboard Cite

show abstract

“…[7][8][9][10] These consistently focus on the feasibility and value of such efforts by assessing components of intraregional susceptibility variations. Var et al 7 analyzed the regional differences in susceptibility among facilities that refer to their own tertiary-care facility, and more recently, Guarascio et al 8 assessed susceptibility among ESKAPE pathogens in hospitals across the state of Pennsylvania. Both of these studies reemphasize the difference in antimicrobial susceptibility rates in urban and suburban regions compared to rural regions.…”

Section: Discussionmentioning

confidence: 99%

Development of a 51-hospital Chicagoland regional antibiogram and comparison to local hospital and national surveillance data

Butler

Biagi

Gupta

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: To develop a regional antibiogram within the Chicagoland metropolitan area and to compare regional susceptibilities against individual hospitals within the area and national surveillance data. Design: Multicenter retrospective analysis of antimicrobial susceptibility data from 2017 and comparison to local institutions and national surveillance data. Setting and participants: The analysis included 51 hospitals from the Chicago–Naperville–Elgin Metropolitan Statistical Area within the state of Illinois. Overall, 18 individual collaborator hospitals provided antibiograms for analysis, and data from 33 hospitals were provided in aggregate by the Becton Dickinson Insights Research Database. Methods: All available antibiogram data from calendar year 2017 were combined to generate the regional antibiogram. The final Chicagoland antibiogram was then compared internally to collaborators and externally to national surveillance data to assess its applicability and utility. Results: In total, 167,394 gram-positive, gram-negative, fungal, and mycobacterial isolates were collated to create a composite regional antibiogram. The regional data represented the local institutions well, with 96% of the collaborating institutions falling within ±2 standard deviations of the regional mean. The regional antibiogram was able to include 4–5-fold more gram-positive and -negative species with ≥30 isolates than the median reported by local institutions. Against national surveillance data, 18.6% of assessed pathogen–antibiotic combinations crossed prespecified clinical thresholds for disparity in susceptibility rates, with notable trends for resistant gram-positive and gram-negative bacteria. Conclusions: Developing an accurate, reliable regional antibiogram is feasible, even in one of the largest metropolitan areas in the United States. The biogram is useful in assessing susceptibilities to less commonly encountered organisms and providing clinicians a more accurate representation of local antimicrobial resistance rates compared to national surveillance databases.

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“… 7–9 Local, regional and national antibiogram data generated from healthcare facilities are key in the monitoring of trends in AMR and guiding the selection of effective antibiotics for empirical therapy. 10 , 11 The development of local hospital antibiograms can therefore serve as the foundation for AMR surveillance, clinical decision support for rational antimicrobial use, and identify areas for intervention by antimicrobial stewardship (AMS) programmes. 12 …”

Section: Introductionmentioning

confidence: 99%

Development of a local antibiogram for a teaching hospital in Ghana

Dodoo

Odoi

Mensah

et al. 2023

JAC-Antimicrobial Resistance

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Background Antimicrobial resistance threatens adequate healthcare provision against infectious diseases. Antibiograms, combined with patient clinical history, enable clinicians and pharmacists to select the best empirical treatments prior to culture results. Objectives To develop a local antibiogram for the Ho Teaching Hospital. Methods This was a retrospective cross-sectional study, using data collected on bacterial isolates from January–December 2021. Samples from urine, stool, sputum, blood, and cerebrospinal fluid (CSF) were considered as well as, aspirates and swabs from wound, ears and vagina of patients. Bacteria were cultured on both enrichment and selective media including blood agar supplemented with 5% sheep blood and MacConkey agar, and identified by both the VITEK 2 system and routine biochemical tests. Data on routine culture and sensitivity tests performed on bacterial isolates from patient samples were retrieved from the hospital’s health information system. Data were then entered into and analysed using WHONET. Results In all, 891 pathogenic microorganisms were isolated from 835 patients who had positive culture tests. Gram-negative isolates accounted for about 77% of the total bacterial species. Escherichia coli (246), Pseudomonas spp. (180), Klebsiella spp. (168), Citrobacter spp. (101) and Staphylococcus spp. (78) were the five most isolated pathogens. Most of the bacterial isolates showed high resistance (>70%) to ampicillin, piperacillin, ceftazidime, ceftriaxone, cefotaxime, penicillin G, amoxicillin, amoxicillin/clavulanic acid, ticarcillin/clavulanic acid and trimethoprim/sulfamethoxazole. Conclusions The isolates from the various samples were not susceptible to most of the antibiotics used in the study. The study reveals the resistance patterns of E. coli and Klebsiella spp. to some antibiotics on the WHO ‘Watch’ and ‘Reserve’ lists. Using antibiograms as part of antimicrobial stewardship programmes would optimize antibiotic use and preserve their efficacy.

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Development of a Statewide Antibiogram to Assess Regional Trends in Antibiotic-Resistant ESKAPE Organisms

Abstract: Development of a regional cumulative antibiogram that targets key ESKAPE pathogens is feasible, while observed trends may help aid future antimicrobial stewardship efforts.

Cited by 11 publications

References 20 publications

Creation of State Antibiogram and Subsequent Launch of Public Health–Coordinated Antibiotic Stewardship in New Hampshire: Small State, Big Collaboration

Creation of State Antibiogram and Subsequent Launch of Public Health–Coordinated Antibiotic Stewardship in New Hampshire: Small State, Big Collaboration

Development of a 51-hospital Chicagoland regional antibiogram and comparison to local hospital and national surveillance data

Development of a local antibiogram for a teaching hospital in Ghana

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