Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-28T04:54:27.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Utilization of cumulative antibiograms for public health surveillance: Trends in Escherichia coli and Klebsiella pneumoniae susceptibility, Massachusetts, 2008–2018

Published online by Cambridge University Press:  27 August 2020

Quynh T. Vo Open the ORCID record for Quynh T. Vo [Opens in a new window] ,
R. Monina Klevens ,
Barbara Bolstorff ,
Kerri Barton ,
Melissa Cumming ,
Jennifer A. Blumenthal ,
T. Scott Troppy ,
Joseph M. Gerth  and
Alfred DeMaria Jr
Quynh T. Vo*
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
R. Monina Klevens
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
Barbara Bolstorff
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
Kerri Barton
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
Melissa Cumming
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
Jennifer A. Blumenthal
Affiliation:
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
T. Scott Troppy
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
Joseph M. Gerth
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
Alfred DeMaria Jr
Affiliation:
Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, Massachusetts
*
Author for correspondence: Quynh T. Vo, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Antimicrobial resistance is an urgent public health threat. Identifying trends in antimicrobial susceptibility can inform public health policy at the state and local levels.

Objective:

To determine the ability of statewide antibiogram aggregation for public health surveillance to identify changes in antimicrobial resistance trends.

Design:

Facility-level trend analysis.

Methods:

Crude and adjusted trend analyses of the susceptibility of Escherichia coli and Klebsiella pneumoniae to particular antibiotics, as reported by aggregated antibiograms, were examined from 2008 through 2018. Multivariable regression analyses via generalized linear mixed models were used to examine associations between hospital characteristics and trends of E. coli and K. pneumoniae susceptibility to ciprofloxacin and ceftriaxone.

Results:

E. coli and K. pneumoniae showed inverse trends in drug susceptibility over time. K. pneumoniae susceptibility to fluoroquinolones increased by 5% between 2008 and 2018 (P < .05). In contrast, E. coli susceptibility declined during the same period to ceftriaxone (6%), gentamicin (4%), and fluoroquinolones (4%) (P < .05). When compared to Boston hospitals, E. coli isolates from hospitals in other regions had a >4% higher proportion of susceptibility to ciprofloxacin and a >3% higher proportion of susceptibility to ceftriaxone (P < .05). Isolates of K. pneumoniae had higher susceptibility to ciprofloxacin (>3%) and ceftriaxone (>1.5%) in all regions when compared to Boston hospitals (P < .05).

Conclusions:

Cumulative antibiograms can be used to monitor antimicrobial resistance, to discern regional and facility differences, and to detect changes in trends. Furthermore, because the number of years that hospitals contributed reports to the state-level aggregate had no significant influence on susceptibility trends, other states should not be discouraged by incomplete hospital compliance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 2 , February 2021 , pp. 169 - 175
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, CDC; 2019.Google Scholar
Klein, EY, Van Boeckel, TP, Martinez, EM, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A 2018;115:E3463–E3470.CrossRefGoogle ScholarPubMed
Tang, KL, Caffrey, NP, Nóbrega, DB, et al. Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis. Lancet Planet Health 2017;1:e316–e327. [Correction in Lancet Planet Health 2017;1:e359].CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013. Atlanta, GA: CDC; 2013.Google Scholar
Hindler, JF, Stelling, J. Analysis and presentation of cumulative antibiograms: a new consensus guideline from the clinical and laboratory standards institute. Clin Infect Dis 2007;44:867–873.CrossRefGoogle ScholarPubMed
Fernández, J, Vazquez, F. The importance of cumulative antibiograms in diagnostic stewardship. Clin Infect Dis 2019;69:1086–1087.Google ScholarPubMed
Guarascio, AJ, Brickett, LM, Porter, TJ, Lee, ND, Gorse, EE, Covvey, JR. Development of a statewide antibiogram to assess regional trends in antibiotic-resistant ESKAPE organisms. J Pharm Pract 2019;32:19–27.CrossRefGoogle ScholarPubMed
Hostler, CJ, Moehring, RW, Ashley, ESD, et al. Feasibility and value of developing a regional antibiogram for community hospitals. Infect Control Hosp Epidemiol 2018;39:718–722.CrossRefGoogle ScholarPubMed
Boehme, MS, Somsel, PA, Downes, FP. Systematic review of antibiograms: a national laboratory system approach for improving antimicrobial susceptibility testing practices in Michigan. Public Health Rep 2010;125 suppl 2:63–72.CrossRefGoogle ScholarPubMed
Dellit, DH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.CrossRefGoogle Scholar
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.Google Scholar
Food, US and Administration, Drug. Drug Safety Communications: FDA Reinforces Safety Information About Serious Low Blood Sugar Levels and Mental Health Side Effects With Fluoroquinolone Antibiotics; Requires Label Changes. Silver Spring, MD: US Department of Health and Human Services, FDA; 2018.Google Scholar
Clinical and Laboratory Standards Institute. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data, Approved Guideline, 4th edition. CLSI document M39-A4. Wayne, PA: CLSI, 2014.Google Scholar
Emergency preparedness regions. Massachusetts Department of Public Health, Office of Preparedness and Emergency Management website. https://www.mass.gov/doc/map-bt-regions-by-coalitionspdf/download. Accessed May 6, 2020.Google Scholar
The Center for Disease Dynamics, Economics & Policy. Antibiotic Resistance of Escherichia coli and Klebsiella pneumoniae in United States. ResistanceMap website. https://resistancemap.cddep.org/AntibioticResistance.php. Published 2020. Accessed January 2, 2020.Google Scholar
Spellberg, B, Doi, Y. The rise of fluoroquinolone-resistant Escherichia coli in the community: scarier than we thought. J Infect Dis 2015;212:1853–1855.CrossRefGoogle ScholarPubMed
Dalhoff, A. Global fluoroquinolone resistance epidemiology and implications for clinical use. Interdiscip Perspect Infect Dis 2012;2012:976273.CrossRefGoogle Scholar
Pitout, JD, DeVinney, R. Escherichia coli ST131: a multidrug-resistant clone primed for global domination. F1000Res. 2017;6:195.CrossRefGoogle Scholar
Cusini, A, Herren, D, Bütikofer, L, Plüss-Suard, C, Kronenberg, A, Marschall, J. Intrahospital 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.CrossRefGoogle Scholar
Abat, C, Raoult, D, Rolain, JM. Decreasing level of resistance in invasive Klebsiella pneumoniae strains isolated in Marseille, January 2012–July 2015. Springerplus 2016;5:631.CrossRefGoogle Scholar
Kochar, S, Sheard, T, Sharma, R, et al. Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae . Infect Control Hosp Epidemiol 2009;30:447–452.CrossRefGoogle ScholarPubMed
Calfee, DP. Recent advances in the understanding and management of Klebsiella pneumoniae . F1000Res. 2017;6:1760.CrossRefGoogle ScholarPubMed
MacFadden, DR, Fisman, DN, Hanage, WP, Lipsitch, M. The relative impact of community and hospital antibiotic use on the selection of extended-spectrum beta-lactamase–producing Escherichia coli . Clin Infect Dis 2019;69:182–188.CrossRefGoogle ScholarPubMed
Collignon, P. Resistant Escherichia coli—we are what we eat. Clin Infect Dis 2009;49:202–204.CrossRefGoogle ScholarPubMed
100 great hospitals in America, 2019. Becker’s Hospital Review website. https://www.beckershospitalreview.com/lists/100-great-hospitals-in-america-2019.html. Published April 12, 2019. Accessed on January 2, 2020.Google Scholar
Var, SK, Hadi, R, Khardori, NM. Evaluation of regional antibiograms to monitor antimicrobial resistance in Hampton Roads, Virginia. Ann Clin Microbiol Antimicrob 2015;14:22.CrossRefGoogle ScholarPubMed
Hostler, CJ, Moehring, RW, Ashley, ESD, et al. Feasibility and value of developing a regional antibiogram for community hospitals. Infect Control Hosp Epidemiol 2018;39:718–722.CrossRefGoogle ScholarPubMed
Peña, SA, Estes, M. Cumulative regional and statewide antibiogram using WHONET and National Healthcare Safety Network (NHSN) Antimicrobial Resistance (AR) Module data. In: Program and Abstracts of The Society for Healthcare Epidemiology of America (SHEA) Spring 2019 Conference; April 24–26, 2019; Boston, MA. Poster 276.Google Scholar
Centers for Medicare & Medicaid Services. Medicare and Medicaid programs; hospital and critical access hospital (CAH) changes to promote innovation, flexibility, and improvement in patient care: a proposed rule by the Centers for Medicare & Medicaid Services. Federal Register. 2016;81 FR 39447:39447-39480.Google Scholar
National Committee for Clinical Laboratory Standards. 2002 Analysis and Presentation of Cumulative Susceptibility Test Data, Approved Guidelines. NCCLS document M39-A. Wayne, PA: National Committee for Clinical Laboratory Standards, 2002.Google Scholar
Zapantis, A, Lacy, MK, Horvat, RT, et al. Nationwide antibiogram analysis using NCCLS M39-A guidelines. J Clin Microbiol 2005;43:2629–2634.CrossRefGoogle ScholarPubMed
Fridkin, SK, Edwards, JR, Tenover, FC, Gaynes, RP, McGowan, JE Jr Antimicrobial resistance prevalence rates in hospital antibiograms reflect prevalence rates among pathogens associated with hospital-acquired infections. Clin Infect Dis 2001;33:324–329.CrossRefGoogle ScholarPubMed
Duffy, J, Sievert, D, Rebmann, C, et al. Effective state-based surveillance for multidrug-resistant organisms related to health care-associated infections. Public Health Rep 2011;126:176–185.CrossRefGoogle ScholarPubMed
Van Beneden, CA, Lexau, C, Baughman, W, et al. Aggregated antibiograms and monitoring of drug-resistant Streptococcus pneumoniae . Emerg Infect Dis 2003;9:1089–1095.CrossRefGoogle ScholarPubMed
El-Azizi, M, Mushtaq, A, Drake, C, et al. Evaluating antibiograms to monitor drug resistance. Emerg Infect Dis 2005;11:1301–1302.CrossRefGoogle ScholarPubMed
New York City antibiogram. New York City Department of Health and Mental Hygiene website. https://www1.nyc.gov/site/doh/providers/resources/antibiogram.page. Accessed on January 2, 2020.Google Scholar
State and regional antibiogram, 2017. Virginia Department of Health website. http://www.vdh.virginia.gov/content/uploads/sites/13/2018/11/2017-Virginia-State-and-Regional-Cumulative-Antibiogram.pdf. Published November 9, 2018. Accessed on January 2, 2020.Google Scholar
Los Angeles Country regional antibiogram. County of Los Angeles Department of Public Health website. http://rx.ph.lacounty.gov/RxAntibiogram0318. Published March 15, 2018. Accessed on January 3, 2020.Google Scholar
van Santen, KL, Edwards, JR, Webb, AK, et al. The standardized antimicrobial administration ratio: a new metric for measuring and comparing antibiotic use. Clin Infect Dis 2018;67:179–185.CrossRefGoogle ScholarPubMed
Watson, JR, Wang, L, Klima, J, Moore-Clingenpeel, M, Gleeson, S, Kelleher, K, Jaggi, P. Healthcare claims data: an underutilized tool for pediatric outpatient antimicrobial stewardship. Clin Infect Dis 2017;64:1479–1485.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Vo et al. Supplementary Materials

Vo et al. Supplementary Materials

Download Vo et al. Supplementary Materials(PDF)
PDF 126.8 KB