1856. Comparison of Antibiotic Susceptibility in Hospitals vs. Hospital-Based Emergency Departments

Abstract

BackgroundAntibiotic susceptibility varies by hospital location (inpatient vs. emergency department (ED)) and by geographic location. Despite these differences, hospitals often have one antibiogram to determine empiric guidelines. The purpose of this study was to evaluate a large health system’s bacterial sensitivity for key organisms in the inpatient vs. the ED setting to determine whether ED-specific antibiograms are necessary based on region.MethodsA health-system, consisting of primarily large general community hospitals across 20 US states, evaluated 156 of their hospitals and hospital-based EDs. These hospitals and hospital-based EDs were divided into regions based on geographic area for assessment. Inpatient and ED susceptibilities were then compared and classified based on susceptibility differences (Minimal 0–4, Moderate 5–10, Considerable > 10). One year of susceptibility data for E. coli, P. aeruginosa and S. pneumoniae was evaluated for antibiotic sensitivity.ResultsA total of 171,556 nonduplicative isolates were evaluated including 139,562 E. coli urine isolates (inpatient 41,612, ED 97,950), 28,685 P. aeruginosa (inpatient 19,983, ED 8,702) and 3,309 S. pneumoniae (inpatient 1,565, ED 1,474). The ED was expected to have less resistance than inpatients as ED patients primarily come from a community setting. For E. coli urinary isolates, minimal differences were found for sulfamethoxazole/trimethoprim, and moderate differences were seen in cefazolin and ceftriaxone for the California/Nevada and Texas San Antonio regions. Moderate or considerable differences were seen in nearly all regions for ciprofloxacin. Considerable differences in S. pneuomoniae susceptibilities were seen between the inpatient and ED for azithromycin and penicillin G, while one region also had a considerable difference for levofloxacin. P. aeruginosa had one region with a considerable difference, with the Colorado + Central Kansas regions showing less resistance inpatient than the ED.ConclusionDifferences in inpatient vs. ED bacterial sensitives warrant justification for-specific regions to monitor and develop inpatient and ED-specific antibiograms.Disclosures All authors: No reported disclosures.