Emerging Trends in Public Health
Sharing Session - 60 Minutes
Jose Alexander, MD, D(ABMM), SM, MB(ASCP)
Director - Clinical Microbiologist
AdventHealth Orlando
Luz Caicedo, MPH, CIC, CPH
Infection Preventionist
AdventHealth Celebration
Background
Since 2014, the Florida Department of Health in Orange County (DOH-Orange) has collaborated with the National Association of County and City Health Officials (NACCHO) and Centers for Disease Control and Prevention (CDC) on a Healthcare-Associated Infections (HAI) and Antibiotic Stewardship Demonstration Project. The primary goal of the Antibiotic Stewardship Demonstration Project in Orange County is to develop and distribute tools for the judicious use of antibiotics. On March 1, 2017, the Orange County Antibiogram Task Force (OCATF) was established to identify bacterial resistance patterns in the county, and to provide clinicians with the county antibiotic resistance rates to select appropriate empirical antibiotics. The members of the OCATF included microbiologists, infection preventionists, pharmacists, and epidemiologists. The OCATF collaborated with the clinicians in different hospitals by providing data incorporated into a final Orange County antibiogram report. Establishing baseline antimicrobial susceptibility data will allow Orange County to track changes in resistance trends yearly.
Methods
Data obtained to develop the Orange County antibiogram were collected from January 2017 to June 2018. Participating acute care hospitals in Orange County submitted their individual facility antibiograms which were aggregated to produce the final antibiogram. Antibiogram data were collected from Florida Hospital (FH) Orlando, FH East, FH Winter Park and Orlando VA Medical Center from January 2017 to December 2017; antibiogram data obtained from Orlando Regional Medical Center and Dr. Phillips Hospital were collected from July 2017 to June 2018.
The percentage of susceptible organisms from each organism/antimicrobial combination were converted to number of isolates using the total number of isolates tested against each antimicrobial. Calculations included the total number of isolates tested against an antimicrobial, the total number of susceptible isolates from each facility and the percentage of susceptible isolates. When data of an organism/antimicrobial was not reported from a facility involved in the project, the result was not included. All the organism/antimicrobial combination are expressed in percentage of susceptible isolates (%S).
Results
The Orange County antibiogram showed a close distribution of susceptibility patterns between acute care facilities across the county. The percentage of extended-spectrum beta-lactamase (ESBL) carrying organisms in Orange County was below 14% and the carbapenem-resistant Enterobacteriaceae (CRE) rate was less than 2%. The rates of multidrug-resistant Pseudomonas aeruginosa (15%) and Acinetobacter baumannii (37%) indicated these two organisms had the highest level of resistance. Ceftolozane/tazobactam and Ceftazidime/avibactam showed 84% and 75% respectively against P. aeruginosa from the antibiogram.
The distribution between Methicillin-susceptible Staphylococcus aureus (MSSA) (52%) and Methicillin-resistant Staphylococcus aureus (MRSA) (48%) was similar. No Vancomycin-resistant Staphylococcus aureus (VRSA) was reported by the facilities, and 65% of Enterococcus faecium was resistant to Vancomycin, however only 3% of Enterococcus faecalis was resistant to Vancomycin and 98% susceptibility to Ampicillin.
Conclusion
The creation of the Orange County antibiogram reinforced collaboration between acute-care hospitals, microbiologists, infection preventionists, pharmacists and county epidemiologists permitting susceptibility data exchanged, and strengthened Orange County’s efforts to promote the concept of practicing antimicrobial stewardship. The antibiogram will be shared with the clinicians in the community. This project allowed the OCATF to identify potential areas of improvement regarding antimicrobial stewardship practices at the county level.