Pediatric Antimicrobial Susceptibility Trends across the United States

Abstract

Objective.Antimicrobial susceptibility patterns across US pediatric healthcare institutions are unknown. A national pooled pediatric antibiogram (1) identifies nationwide trends in antimicrobial resistance, (2) allows across-hospital benchmarking, and (3) provides guidance for empirical antimicrobial regimens for institutions unable to generate pediatric antibiograms.Methods.In January 2012, a request for submission of pediatric antibiograms between 2005 and 2011 was sent to 233 US hospitals. A summary antibiogram was compiled from participating institutions to generate proportions of antimicrobial susceptibility. Temporal and regional comparisons were evaluated using χ² tests and logistic regression, respectively.Results.Of 200 institutions (85%) responding to our survey, 78 (39%) reported generating pediatric antibiograms, and 55 (71%) submitted antibiograms. Carbapenems had the highest activity against the majority of gram-negative organisms tested, but no antibiotic had more than 90% activity against Pseudomonas aeruginosa. Approximately 50% of all Staphylococcus aureus isolates were methicillin resistant. Western hospitals had significantly lower proportions of S. aureus that were methicillin resistant compared with all other regions tested. Overall, 21% of S. aureus isolates had resistance to clindamycin. Among Enterococcus faecium isolates, the prevalence of susceptibility to ampicillin (25%) and vancomycin (45%) was low but improved over time (P < .01), and 8% of E. faecium isolates were resistant to linezolid. Southern hospitals reported significantly higher prevalence of E. faecium with susceptibilities to ampicillin, vancomycin, and linezolid compared with the other 3 regions (P < .01).Conclusions.A pooled, pediatric antibiogram can identify nationwide antimicrobial resistance patterns for common pathogens and might serve as a useful tool for benchmarking resistance and informing national prescribing guidelines for children.

Changing Susceptibility of Staphylococcus aureus in a US Pediatric Population

“…3,4,6,23 Before 2005, dramatic increases in rates of community-associated MRSA infection were reported, with most studies revealing oxacillin resistance in 40% to 60% of SSTIs. 16,24,25 The rate of rise of MRSA infections slowed by 2005-2006 and subsequently declined. 1-4, 12, 26, 27 A parallel decline in MSSA infections has not been consistently reported, with some authors noting stable rates of MSSA during the same time period.…”

“…Many studies have suggested that despite a high burden of S aureus disease in children, resistance to non-β-lactam antibiotics is relatively uncommon. 1,2,[14][15][16][17] Our study evaluates annual antimicrobial susceptibility trends of S aureus isolates from infections in pediatric patients receiving care in the Military Health System (MHS) treatment facilities from 2005 to 2014. Differences in antimicrobial susceptibility of S aureus between age groups, infection types, patient status (inpatient versus outpatient), and geographical region were examined.…”

The Use of Systemic and Topical Fluoroquinolones

“…28 As expected, when the use of the fluoroquinolones (in particular levofloxacin) increased, the susceptibility of Gram-negative bacilli to ciprofloxacin and levofloxacin significantly decreased. 29 …”

Empiric Combination Therapy for Gram-Negative Bacteremia

“…Our b-lactam and aminoglycoside antibiotic susceptibility percentages, however, appear consistent with a study evaluating antibiotic susceptibility data from 55 contributing institutions caring for children in the United States. 26 Second, although we did not find a benefit of combination therapy in a subgroup analysis of children who had ANCs #100 cells/mL or PRISM III scores $15, there were only 49 and 114 children in these categories, respectively, and we may have been unable to detect a difference in the clinical outcomes of children comparing combination therapy versus monotherapy, if a difference exists. Further prospective studies are needed to evaluate patients in these risk categories.…”

“…Similarly, aztreonam had 83% in vitro activity in a pediatric study of some 33 000 diverse-source Gram-negative isolates. 26 Patients who have an inability to tolerate penicillins may benefit from the routine addition of an aminoglycoside to aztreonam on an empirical basis. In contrast, monotherapy with ceftriaxone (when hospitalacquired Gram-negative infections are unlikely), piperacillin-tazobactam, cefepime, or meropenem will likely suffice.…”