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Pediatric Antimicrobial Susceptibility Trends across the United States

Part of: SHEA Research Network Collection

Published online by Cambridge University Press:  02 January 2015

Pranita D. Tamma ,
Gwen L. Robinson ,
Jeffrey S. Gerber ,
Jason G. Newland ,
Chloe M. DeLisle ,
Theoklis E. Zaoutis  and
Aaron M. Milstone
Pranita D. Tamma*
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Gwen L. Robinson
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Jeffrey S. Gerber
Affiliation:
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Jason G. Newland
Affiliation:
Children's Mercy Hospital, Kansas City, Missouri
Chloe M. DeLisle
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Theoklis E. Zaoutis
Affiliation:
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Aaron M. Milstone
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
*
Johns Hopkins Medical Institutions, Department of Pediatrics, Division of Infectious Diseases, 200 North Wolfe Street, Suite 3155, Baltimore, MD 21287 ([email protected])
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Abstract

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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 12 , December 2013 , pp. 1244 - 1251
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

References

1.Garnacho-Montero, J, Garcia-Garmendia, JL, Barrerò-Almodovar, A, Jimenez-Jimenez, FJ, Perez-Paredes, C, Ortiz-Leyba, C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003;31(12):2742–2751.CrossRefGoogle Scholar
2.Garnacho-Montero, J, Ortiz-Leyba, C, Herrera-Melero, I, et al. Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study. J Antimicrob Chemother 2008;61(2):436–441.CrossRefGoogle Scholar
3.Kang, CI, Kim, SH, Park, WB, et al. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 2005;49:760–766.CrossRefGoogle Scholar
4.Harbarth, S, Garbino, J, Pugin, J, Romand, JA, Lew, D, Pittet, D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003;115:529–535.CrossRefGoogle Scholar
5.Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48(1):1–12.CrossRefGoogle ScholarPubMed
6.Swami, SK, Banerjee, R. Comparison of hospital-wide and age and location-stratified antibiograms of S. aureus, E. coli, and S. pneumoniae: age- and location-stratified antibiograms. Springerplus 2013;2(1):63.CrossRefGoogle ScholarPubMed
7.David, MZ, Crawford, SE, Boyle-Vavra, S, Hostetler, MA, Kim, DC, Daum, RS. Contrasting pediatric and adult methicillin-resistant Staphylococcus aureus isolates. Emerg Infect Dis 2006;12(4):631–637.CrossRefGoogle ScholarPubMed
8.Pakyz, AL. The utility of hospital antibiograms as tools for guiding empiric therapy and tracking resistance: insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2007;27(9):1306–1312.CrossRefGoogle ScholarPubMed
9.Schulz, LT, Fox, BC, Polk, RE. Can the antibiogram be used to assess microbiologic outcomes after antimicrobial stewardship interventions? a critical review of the literature. Pharmacotherapy 2012;32(8):668–676.CrossRefGoogle Scholar
10.Schirmer, P, Mercier, RC, Oda, G, Holodniy, M. Validation of electronic antibiograms for the veterans affairs Palo Alto Health Care System. Paper presented at the International Conference on Healthcare-Associated Infections, March 18-22, 2010; Atlanta, GA.Google Scholar
11.Castrodale, L, Hennessy, T. Combined antibiogram for hospitals with 50+ beds—Alaska, 2002. Alaska Med 2004;46(4):81–87.Google ScholarPubMed
12.Clinical and Laboratory Standards Institute (CLSI). Analysis and presentation of cumulative antimicrobial susceptibility test data. 2nd ed. Approved guideline M39-A2. Wayne, PA: CLSI, 2006.Google Scholar
13.Wieser, A, Schneider, L, Jung, J, Schubert, S. MALDI-TOF MS in microbiological diagnostics: identification of microorganisms and beyond (mini review). Appl Microbiol Biotechnol 2012;93(3):965–974.CrossRefGoogle ScholarPubMed
14.US Department of Commerce. United States census regions. http://www.census.gov/geo/www/us_regdiv.pdf. Accessed July 15, 2013.Google Scholar
15.Jacoby, GA. AmpC beta-lactamases. Clin Microbiol Rev 2009;22(1):161–182.CrossRefGoogle ScholarPubMed
16.Theuretzbacher, U. Accelerating resistance, inadequate antibacterial drug pipelines and international responses. Int J Antimicrob Agents 2012;39(4):295–299.CrossRefGoogle ScholarPubMed
17.Fridkin, SK, Edwards, JR, Tenover, FC, et al. Antimicrobial resistance prevalence rates in hospital antibiograms reflect prevalence rates among pathogens associated with hospital-acquired infections. Clin Infect Dis 2001;33(3):324–330.CrossRefGoogle ScholarPubMed
18.Van Beneden, CA, Lexau, C, Baughman, W, et al. Aggregated antibiograms and monitoring of drug-resistant Streptococcus pneumoniae. Emerg Infect Dis 2003;9(9):1089–1095.CrossRefGoogle ScholarPubMed
19.Chin, AE, Hedberg, K, Cieslak, PR, Cassidy, M, Stefonek, KR, Fleming, DW. Tracking drug-resistant Streptococcus pneumoniae in Oregon: an alternative surveillance method. Emerg Infect Dis 1999;5(5):688–693.CrossRefGoogle ScholarPubMed
20.Washington State Department of Health. Evidence-based monitoring strategies and interventions for antibiotic resistant organisms. http://www.doh.wa.gov/Portals/1/Documents/Pubs/820-051-AntibioticsMRSAReport08.pdf.Google Scholar
21.Lautenbach, E, Nachamkin, I. Analysis and presentation of cumulative antimicrobial susceptibility data (antibiograms):substantial variability across medical centers in the United States. Infect Control Hosp Epidemiol 2006;27(4):409–412.CrossRefGoogle ScholarPubMed
22.Zapantis, A, Lacy, MK, Horvat, RT, et al. Nationwide antibiogram analysis using NCCLS M39-A guidelines. J Clin Microbiol 2005;43(6):2629–2634.CrossRefGoogle ScholarPubMed
23.Horvat, RT, Klutman, NE, Lacy, MK, Grauer, D, Wilson, M. Effect of duplicate isolates of methicillin-susceptible and methicillin-resistant Staphylococcus aureus on antibiogram data. J Clin Microbiol 2003;41(10):4611–4616.CrossRefGoogle ScholarPubMed
24.White, RL, Friedrich, LV, Burgess, DS, Brown, EW, Scott, LE. Effect of removal of duplicate isolates on cumulative susceptibility reports. Diagn Microbiol Infect Dis 2001;39(4):251–256.CrossRefGoogle ScholarPubMed
25.Shannon, KP, French, GL. Antibiotic resistance: effect of different criteria for classifying isolates as duplicates on apparent resistance frequencies. J Antimicrob Chemother 2002;49(1):201–204.CrossRefGoogle ScholarPubMed
26.Magee, JT. Effects of duplicate and screening isolates on surveillance of community and hospital antibiotic resistance. J Antimicrob Chemother 2004;54(1):155–162.CrossRefGoogle ScholarPubMed
27.Bochicchio, GV, Baquero, F, Hsueh, PR, et al. In vitro susceptibilities of Escherichia coli isolated from patients with intraabdominal infections worldwide in 2002-2004: results from SMART (Study for Monitoring Antimicrobial Resistance Trends). Surg Infect 2006;7(6):537–545.CrossRefGoogle ScholarPubMed
28.Baquero, F, Hsueh, PR, Paterson, DL, et al. In vitro susceptibilities of aerobic and facultatively anaerobic gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2005 results from Study for Monitoring Antimicrobial Resistance Trends (SMART). Surg Infect 2009;10:99–104.CrossRefGoogle ScholarPubMed
29.Solomkin, JS, Mazuski, JE, Bradley, JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50(2):133–164.CrossRefGoogle ScholarPubMed
30.Bradley, JS, Jackson, MA; Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011;128(4):e1034–e1045.CrossRefGoogle Scholar
31.Cook, PP, Das, TD, Gooch, M, Catrou, PG. Effect of a program to reduce hospital ciprofloxacin use on nosocomial Pseudomonas aeruginosa susceptibility to quinolones and other antimicrobial agents. Infect Control Hosp Epidemiol 2008;29(8):716–722.CrossRefGoogle ScholarPubMed
32.Boggan, JC, Navar-Boggan, AM, Jhaveri, R. Pediatric-specific antimicrobial susceptibility data and empiric antibiotic selection. Pediatrics 2012;130(3):e615–e622.CrossRefGoogle ScholarPubMed
33.Slain, D, Sarwari, AR, Petros, KO, et al. Impact of a multimodal antimicrobial stewardship program on Pseudomonas aeruginosa susceptibility and antimicrobial use in the intensive care unit setting. Crit Care Res Pract 2011;2011:416–426.Google ScholarPubMed
34.Chow, JW, Fine, MJ, Shlaes, DM, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 1991;115(8):585–590.CrossRefGoogle ScholarPubMed
35.Kaye, KS, Cosgrove, S, Harris, A, Eliopoulos, GM, Carmeli, Y. Risk factors for emergence of resistance to broad-spectrum cephalosporins among Enterobacter spp. Antimicrob Agents Chemother 2001;45(9):2628–2630.CrossRefGoogle ScholarPubMed
36.Jones, RN, Stilwell, MG, Rhomberg, PR, Sader, HS. Antipseudomonal activity of piperacillin/tazobactam: more than a decade of experience from the SENTRY Antimicrobial Surveillance Program (1997-2007). Diagn Microbiol Infect Dis 2009;65(3):331–334.CrossRefGoogle ScholarPubMed
37.Sader, HS, Flamm, RK, Jones, RN. Antimicrobial activity of dap-tomycin tested against gram-positive pathogens collected in Europe, Latin America, and selected countries in the Asia-Pacific Region (2011). Diagn Microbiol Infect Dis 2013;75(4):417–422.CrossRefGoogle ScholarPubMed
38.Flamm, RK, Farrell, DJ, Mendes, RE, Ross, JE, Sader, HS, Jones, RN. ZAAPS program results for 2010: an activity and spectrum analysis of linezolid using clinical isolates from 75 medical centres in 24 countries. J Chemother 2012;24(6):328–337.CrossRefGoogle ScholarPubMed
39.Jones, RN, Ross, JE, Castanheira, M, Mendes, RE. United States resistance surveillance results for linezolid (LEADER Program for 2007). Diagn Microbiol Infect Dis 2008;62(4):416–426.CrossRefGoogle ScholarPubMed
40.Anderson, DJ, Miller, B, Marfatia, R, Drew, R. Ability of an antibiogram to predict Pseudomonas aeruginosa susceptibility to targeted antimicrobials based on hospital day of isolation. Infect Control Hosp Epidemiol 2012;33(6):589–593.CrossRefGoogle ScholarPubMed