Analysis and comparison of cumulative statewide antibiograms for wisconsin 2006 and 2008
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Analysis and Comparison of Cumulative Statewide Antibiograms for Wisconsin, 2006 and 2008. Christina M. Carlson 1 , Tam T. Van 2 , Steve A. Marshall 2 , David M. Warshauer 2 , and Peter A. Shult 2 1 MPH Program, University of Wisconsin - Madison

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Analysis and Comparison of Cumulative Statewide Antibiograms for Wisconsin, 2006 and 2008

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Analysis and comparison of cumulative statewide antibiograms for wisconsin 2006 and 2008

Analysis and Comparison of Cumulative Statewide Antibiograms for Wisconsin, 2006 and 2008

Christina M. Carlson1, Tam T. Van2, Steve A. Marshall2, David M. Warshauer2, and Peter A. Shult2

1MPH Program, University of Wisconsin - Madison

2Wisconsin State Laboratory of Hygiene, Communicable

Diseases Division


Antimicrobial resistance an ever increasing public health problem

Antimicrobial Resistance: An ever-increasing public health problem

  • U.S. Healthcare-associated infections:

    -1.7 million infections (1 in 10 patients)

    -99,000 associated deaths/yr

    -6.7 billion annual economic burden (2002)

  • Staphylococcus aureus

    ->95% of penicillin resistant

    -60% methicillin resistant

  • >20% of all Enterococcus infections resistant to Vancomycin

Source: CDC. 2009. Antimicrobial resistance in healthcare settings fact sheet.


Antimimicrobial resistance trends

Vancomycin-resistant Enterococi

Among ICU Patients,

1995-2004

Methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) Among ICU Patients, 1995-2004

Antimimicrobial Resistance: Trends

Fluoroquinolone-resistant Pseudomonas aeruginosa Among ICU Patients,1995-2004

3rd generation cephalosporin-resistant Klebsiella pneumoniae Among ICU Patients,1995-2004

Source: CDC: National Nosocomial Infections Surveillance System. 2009.


Antibiogram

Antibiogram:

An overall profile of the antibiotic susceptibility of an organism to a collection of antimicrobial agents routinely tested and used

  • Monitor resistance trends

  • Reveal emergence of potential novel resistance

  • Aid clinicians in empiric treatment of infections

  • Problem: Lack of standardized data

  • Clinical Laboratory Standards Institute guidelines for preparation of antibiograms


A cumulative statewide antibiogram for wisconsin

A Cumulative Statewide Antibiogram for Wisconsin

Study Goals:

  • Compare WI’s antimicrobial susceptibility status in 2006 and 2008

  • Assess current challenges and needs regarding antimicrobial susceptibility testing (AST) in WI


Methods

Methods

  • Preparation of cumulative antibiogram

    -requested 2008 antibiograms from 135 clinical/ reference laboratories in WI

    -calculated average % susceptibility for selected antimicrobial agent-organism combinations

    -2008 cumulative susceptibility patterns compared with 2006

  • Evaluation of antibiograms

    -CLSI M39-A2 and M100-S19 documents

    -WI adherence to CLSI guidelines compared with adherence nationally


Local regional anti biograms received from wi healthcare facilities performing ast

Local & regional anti-biograms received from WI healthcare facilities performing AST

  • 47 of the 87 (54%) healthcare facilities performing AST contributed antibiograms in 2006 and 2008

  • 28 common sites provided antibiograms in 2006 and 2008

Provided an antibiogram in 2006

Provided an antibiogram in 2008

Provided an antibiogram in both 2006 & 2008


Comparison of local regional antibiograms in wi and nationwide meeting clsi recommendations

Comparison of local/regional antibiograms in WI and nationwide meeting CLSI recommendations

  • WI antibiograms showed at least 70% compliance to 4 of the 6 CLSI elements analyzed

  • Adherence to CLSI guidelines in 2008 WI antibiograms, as compared to 2006, improved in all elements analyzed, except 1) reporting verified susceptibility results and 2) indicating the use of duplicates

Nationwide data is from: Zapantis et. al. 2005 JCM, 43:2629. It includes antibiograms from 2000 – 2002.


Wi cumulative statewide antibiogram for 2008

Indicates a ≥10% decrease in susceptibility as compared to 2006

WI cumulative statewide antibiogram for 2008

Indicates a ≥10% increase in susceptibility as compared to 2006


Wi cumulative statewide antibiogram for 20081

Indicates a ≥10% decrease in susceptibility as compared to 2006

WI cumulative statewide antibiogram for 2008

Indicates a ≥10% increase in susceptibility as compared to 2006


Conclusions

Conclusions

  • WI healthcare facilities can improve on current antibiograms by:

    1) excluding duplicates from their data and indicating so

    2) excluding susceptibility data for organisms with <10 isolates

  • WI susceptibility data for 2008 is largely comparable to that of 2006, and overall susceptibility patterns in WI show less resistance compared to the nation

  • Susceptibility patterns among multiple organism-agent combinations between 2006 & 2008 statewide antibiograms suggest the need for increased adherence to CLSI practice guidelines in WI

  • Statewide antibiograms should only be used for surveillance purposes and not to guide empiric therapy for individual patients YET…


Future directions

Future Directions

  • Develop a standardized & sustainable strategy to the development of an annual statewide antibiogram for WI

    -survey a subset of high capacity laboratories in each public health region

    -a more precise and accurate statewide antibiogram useful to facilities that cannot/do not compile their own

  • Continued development of WSLH-sponsored surveys, workshops, teleconferences, webinars aimed at monitoring & improving AST practices in WI healthcare facilities


Acknowledgements

Acknowledgements

Capstone Committee

 Steve Marshall, MS

 David Warshauer, PhD

 Christopher Olsen, DVM, PhD

UW MPH Program

 Patrick Remington

 Barbara Duerst

 Heather Cote

WI State Laboratory of Hygiene

 Charles Brokopp, DrPH

 Peter Shult, PhD

 Tam Van, PhD (CDC EID Fellow)


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