Local Antibiogram Research Articles

Antibiogram of Multidrug-Resistant Bacteria Based on Sepsis Onset Location in Korea: A Multicenter Cohort Study.

Administration of adequate antibiotics is crucial for better outcomes in sepsis. Because no uniform tool can accurately assess the risk of multidrug-resistant (MDR) pathogens, a local antibiogram is necessary. We aimed to describe the antibiogram of MDR bacteria based on locations of sepsis onset in South Korea. We performed a prospective observational study of adult patients diagnosed with sepsis according to Sepsis-3 from 19 institutions (13 tertiary referral and 6 university-affiliated general hospitals) in South Korea. Patients were divided into four groups based on the respective location of sepsis onset: community, nursing home, long-term-care hospital, and hospital. Along with the antibiogram, risk factors of MDR bacteria and drug-bug match of empirical antibiotics were analyzed. MDR bacteria were detected in 1,596 (22.7%) of 7,024 patients with gram-negative predominance. MDR gram-negative bacteria were more commonly detected in long-term-care hospital- (30.4%) and nursing home-acquired (26.3%) sepsis, whereas MDR gram-positive bacteria were more prevalent in hospital-acquired (10.9%) sepsis. Such findings were consistent regardless of the location and tier of hospitals throughout South Korea. Patients with long-term-care hospital-acquired sepsis had the highest risk of MDR pathogen, which was even higher than those with hospital-acquired sepsis (adjusted odds ratio, 1.42; 95% confidence interval, 1.15-1.75) after adjustment of risk factors. The drug-bug match was lowest in patients with long-term-care hospital-acquired sepsis (66.8%). Gram-negative MDR bacteria were more common in nursing home- and long-term-care hospital-acquired sepsis, whereas gram-positive MDR bacteria were more common in hospital-acquired settings in South Korea. Patients with long-term-care hospital-acquired sepsis had the highest the risk of MDR bacteria but lowest drug-bug match of initial antibiotics. We suggest that initial antibiotics be carefully selected according to the onset location in each patient.

Acute management of pneumonia in adult patients.

Acute management of pneumonia in adult patients.

AntibiogramDSM: a combined local antibiogram and educational intervention.

To describe the development of a combined local antibiogram and assess its utility in an educational intervention. Retrospective analysis of a combined, multi-healthcare system antibiogram with an educational intervention and pre-post analysis. Creation of the combined antibiogram included all health systems in Des Moines, Iowa. The educational intervention was delivered live via webinar and remained available on demand for one year. The combined antibiogram participants included four health systems representing eight hospitals. The educational intervention included 45 healthcare providers (15 live, 30 on demand) who elected to participate. Yearly antibiograms were collected from four health systems for 2017 and 2018 and from three health systems for 2019 and 2020. Each was aggregated into a single antibiogram, posted online, and analyzed retrospectively. In 2021, an educational intervention took place, which included pre-educational assessments, a one-hour presentation on local resistance rates and impact on common infections, and post-education assessments. The educational session was available online for one year. Correct responses before and after education were compared using NcNemar's test. Over 4 yr, 123,168 isolates were included in the antibiogram, representing 57 species and 46 tested antibiotics. Before education, prediction of local resistance rates for E. coli and S. pneumoniae was poor. After the education session, there was improvement in the proportion of correct responses to case-based questions: pneumonia (31.8% vs 58.8%, P = 0.022), UTI (47.7% vs 85.3%, P < 0.001), sinusitis (75% vs 91.2%, P = 0.109), and diverticulitis (43.2% vs 88.2%, P = 0.002). A combined local antibiogram was useful in supporting an outpatient education program.

Financial burden on the parents of children infected with extensively drug resistant Salmonella infection

Background: Typhoid illness is a significant cause of morbidity in Pakistan. This study aimed to determine the financial burden on parents of children infected with extensively drug-resistant (XDR) salmonella infection.&#x0D; Patients and methods: This observational study included 159 patients aged 6 months to 13 years admitted through OPD/ER of Karachi Adventist Hospital with the diagnosis of enteric fever and intravenous antibiotics started as per local antibiogram. To remove recall bias antibiotic cost before hospitalization was not included. All those patients who were culture positive for XDR salmonella, either continued or shifted to newer antibiotics as per susceptibility pattern were included. Depending upon the type and duration of antibiotic therapy cost was calculated in Pakistani rupee (1 USD = ~225 PKR).&#x0D; Results: Total 60.4% of patients aged less than 7.5 years; 62.3% were male, 41.5% from urban areas, 15.1% had graduated mothers, 27% had graduated fathers, 5.7% uses boiled water, and 1.9% typhoid vaccination. In 54.1% of patients antibiotic cost reached &gt;40k PKR. Patients with urban dwelling were 0.29 times less likely for higher cost, increase in duration of fever (&gt;7 days) at admission increased the cost 5.73 times, XDR samples found 13.5 time more likely for higher cost, and TLC between 4000 – 11000/mm3 gave negative association with higher cost.&#x0D; Conclusion: The burden of XDR salmonella infection is heavy and is related to urban residence, duration of fever at admission, and length of hospital stay.

1440. Local Antibiogram for Mycobacterium abscessus Shows Variability from Previously Published Susceptibility Data

Abstract Background Mycobacterium abscessus complex (MabsC) causes a wide variety of human disease and is frequently resistant to multiple agents. Empiric therapy is typically based on previously published susceptibility data which suggests amikacin (AMK), cefoxitin (FOX), clarithromycin (CLR), and imipenem (IPM) should be utilized. However, there is considerable variability in susceptibility patterns according to locale. We generated an antibiogram based on local MabsC isolates and compared it to previously reported susceptibility data to determine if local variation exists and assist in empiric therapy choice. Methods Non-duplicate local isolates of MabsC from 2011-2021 with in-vitro susceptibility data (via broth microdilution per CLSI guidance) available were included in the generation of a local antibiogram. This included standard 14 day incubation for inducible macrolide resistance. A review of the literature via PubMed search was undertaken to generate comparator susceptibility patterns with a focus on published reports with greater than 20 isolates. Results Sixty one unique local isolates of MabsC were identified, 44 of which were from lung, eight skin/soft tissue, five bone/joint, two blood, one urine, and one ascitic fluid. Susceptibilities are shown in Table 1. Twenty one manuscripts described susceptibility patterns with a range of isolates from 20 to 404 with a median of 70. These revealed susceptibility ranges for AMK range from 45-100%, FOX 0-72%, CLR 19-96%, and IPM 0%-71% as seen in Table 2. Susceptibilities of Mycobacterium abscessus isolates Results of antimicrobial susceptibility testing for 61 isolates of MabsC with percent resistant, intermediate, and susceptible shown, along with break points used per CLSI Comparison of Drug Susceptibility Rates from Previous Studies Conclusion We found high local resistance rates to cefoxitin and imipenem in contrast to empiric therapy recommendations and greatest susceptibility to amikacin. Published data shows a wide variation of susceptibility patterns to the recommended therapies based on location. It would be clinically advantageous for institutions to generate an antibiogram based on their local resistance data to assist empiric therapy choices in MabsC infections. Our data suggests that such local antibiograms could lead to substantial changes from the recommended empiric therapy at the institutional level for these infections which are historically challenging to treat. Disclosures Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant.

1297. Design and Testing of an Interactive Module for Improving Understanding and Application of Institutional Antibiograms

Abstract Background Many infectious diseases treatment guidelines recommend incorporating local antibiograms (ABs) into treatment decisionmaking. However, studies suggest many healthcare provider trainees are uncomfortable using ABs and rarely incorporate them into their decisionmaking. Our purpose was to develop a brief online module to develop skills in locating and utilizing an institutional AB and to gather feedback on its utility. Interactive Module for Understanding and Interpreting Antibiograms Screen captures displaying initial framing case with learner response (upper left), stepwise navigation of an antibiogram (upper right), embedded task practice (lower left) , and question from final competency assessment (lower right). Methods We developed and tested the module at the University of California San Francisco, with initial testing among 340 pharmacy students during microbiology instruction. We used the Four-Component Instructional Design framework to inform our design approach. Using the Articulate Storyline platform, we developed an interactive online learning module (Figure 1). The module began with a patient case to introduce the whole task and activate prior knowledge, with learners required to enter a freetext answer to the case prompt. Using visuals and narration with captions, the module then reviewed the basics of an AB and how to use an AB for therapy with known pathogens and for empiric therapy, and use of location-specific and combination ABs. Task practice was provided by case-based questions requiring learner response and providing immediate feedback. The module ended with competency assessment questions including revisiting the original case and the learner's initial answer. Learners completing the module were directed to complete a survey to provide feedback on the module; we report quantitative and qualitative feedback from the survey. Results We received 131 survey responses (38.5%). 111/131 (85%) rated the educational value of the module as “Extremely valuable”, and 103/131 (79%) rated the module as having “Excellent usability”. Primary themes among positive feedback included the interactive elements, stepwise approach, and questions with feedback; constructive feedback included desire for speed control of the narration and sound quality. Conclusion An interactive online module for learning about ABs was highly rated by learners and may be valuable to help clinicians apply ABs in practice. Future studies should include other health professions learners, delayed assessment to measure retention, and customization for different institutional ABs. Disclosures Conan MacDougall, PharmD, MAS, Merck: Advisor/Consultant.

174. Evaluation of FilmArray® Blood Culture Identification and TheraDoc® Utilization at a Veterans Affairs Health Care System

Abstract Background Bacteremia is associated with significant morbidity and mortality, with each hour of delay initiating antibiotics associated with a 7.6% decrease in survival rate. At the Salisbury Veterans Affairs Health Care System (VA HCS), FilmArray® Blood Culture Identification (BCID) is used along with TheraDoc® to assist with selection of antimicrobial regimens as an antimicrobial stewardship practice at the site. The purpose of this study is to evaluate the time to appropriate antibiotic therapy based on positive BCID results. Methods This study is a retrospective, quality assurance project conducted at a 284-bed VA medical center from May 2018 through December 2020 of Veterans with positive BCID results identified on TheraDoc®. The primary endpoint is to identify the mean time for initiation of appropriate antimicrobial therapy defined as at least 80% susceptibility on local antibiogram to the resulting BCID organism for Veterans not on antibiotics or on inappropriate therapy from the time of BCID positivity. Secondary endpoints include comparing time to appropriate therapy with or without Infectious Diseases (ID) and Antimicrobial Stewardship Program (ASP) coverage, time to de-escalation, and contributors to time delays. Results A total of 168 Veterans were included in the study with 138 Veterans (82%) receiving appropriate antibiotic therapy at the time of BCID results and 30 Veterans (18%) on inappropriate or no empiric antibiotics. The mean time to appropriate therapy of the 30 Veterans on inappropriate or no antibiotics at the time of BCID positivity was 13 hours and 54 minutes with provider order entry being the largest factor in time delays. Of these 30 Veterans, BCID positivity occurred in 6 Veterans during business hours with onsite availability to ID and ASP to which the mean time to appropriate therapy was 3 hours and 29 minutes compared to 16 hours and 30 minutes for the 24 Veterans with results outside of business hours. For the 138 Veterans on appropriate therapy, the average time to de-escalation was about 43 hours and 52 minutes. Percentage of ID and/or ASP involvement. This pie chart shows the percentages of Veterans with ID and/or ASP involvement. Time to de-escalation. This graph demonstrates the time to de-escalation for Veterans on appropriate therapy at the time of BCID positivity. Inappropriate Therapy Group. This graph compares time to appropriate therapy between results occurring during business hours or outside of business hours for Veterans on no initial antibiotics or inappropriate therapy. Conclusion BCID and TheraDoc® are helpful antimicrobial stewardship tools to assist with reducing time to appropriate therapy when consistently monitored. Additional resources and education may be of benefit to providers covering outside of business hours. Example of BCID Algorithm Creation of a local BCID algorithm has been started as a result of this study. The goal of this resource is to be a tool for providers to help guide therapeutic decisions when ID and/or ASP are not readily available. Disclosures All Authors: No reported disclosures.

597. Are We Dosing Correctly? Population Pharmacokinetic Modeling of Cefepime, Piperacillin-Tazobactam, and Meropenem in Individuals with Cystic Fibrosis

Abstract Background Patients with cystic fibrosis (CF) experience recurrent bacterial pulmonary exacerbations. The management of these infections becomes increasingly complex due to decreased antimicrobial susceptibility and inadequate pharmacokinetic/pharmacodynamic (PK/PD) characterization of the most commonly used antimicrobial agents in this population. Methods One hundred fifty-five pediatric and adult participants receiving cefepime (n=82), meropenem (n=42), or piperacillin-tazobactam (n=31) were enrolled. Opportunistic blood samples were obtained during hospitalization. Population PK (PopPK) analysis was conducted using nonlinear mixed effects modeling in NONMEM, and clinical and demographic characteristics were evaluated as potential covariates. Monte Carlo simulations evaluated the probability of PK/PD target attainment (PTA) for different dosing regimens. Multiple targets, defined as percentage of a 24-h time period that the free drug concentration exceeds the MIC (fT &amp;gt; MIC), were selected based on prior studies of beta-lactam antibiotics. Results Preliminary PopPK modeling results show that lean body weight, creatinine clearance, daily dose, mode of administration (standard vs. extended infusion), and age affect PK parameters, with varying effects by drug. As anticipated, extended or continuous infusions resulted in higher PTA (Table 1). In the cefepime group, the 3-h infusion regimen achieved higher PTAs than the 0.5-h regimen across all age groups (Figure 1, Figure 2). Estimated breakpoints (in which ≥ 90% of patients are expected to achieve a PK/PD target) were 2-4 fold higher in pediatric participants receiving a 3-h infusion vs. 0.5-h infusion, based on age and target fT &amp;gt; MIC (Table 1). In the meropenem group, increased creatinine clearance led to reduced PTA, and in the piperacillin-tazobactam group, total daily dose and interval were the principal drivers of PTA. Table 1:Breakpoints (mg/L, highest minimum inhibitory concentration (MIC) with ≥ 90% PK target attainment) for different infusion durations, based on Monte Carlo simulations.Figure 1:Comparison of PTA between the two durations of infusion for 50 mg/kg (3 to 11 years) or 2 g (12 years and above) cefepime q8h at the target of 65% fT&amp;gt; MIC.Figure 2:Comparison of PTA between two durations of infusion for 50 mg/kg (3 to 11 years) or 2 g (12 years and above) cefepime q8h at the target of 100% fT&amp;gt; MIC. Conclusion To our knowledge, this is the largest PopPK study to date of these antimicrobials in individuals with CF. Clinicians should incorporate local antibiograms with these PopPK models to determine optimal dosing in patients with CF, since standard dosing regimens may fail to achieve specific PK/PD targets. This population may also benefit from beta-lactam therapeutic drug monitoring. Disclosures C. Buddy Creech, MD, MPH, Altimmune: Advisor/Consultant|Astellas: Advisor/Consultant|Merck: Grant/Research Support|Premier: Advisor/Consultant.

Antibiotic resistance of uropathogens among the community-dwelling pregnant and nonpregnant female: a step towards antibiotic stewardship

BackgroundIndiscriminate and widespread use of antibiotics has resulted in emergence of many antibiotic-resistant organisms. Antibiotic administration during pregnancy is mostly avoided, unless there is compelling medical condition. We hypothesized that the uropathogens isolated from pregnant women would be more susceptible to antibiotics compared to those isolated from nonpregnant women, thus will be helpful in formulating separate empiric guideline for pregnant women based on the resistance pattern.MethodsThis was a prospective cross-sectional study conducted over a period of 2 years in which females with the clinical diagnosis of either cystitis or asymptomatic bacteriuria during pregnancy were included from the community settings. Uropathogen species and their antimicrobial resistance pattern were compared between the pregnant and nonpregnant groups. After accounting for centre-to-centre variation and adjusting for age and socio-economic status, the adjusted odds ratio for antibiotic resistance was calculated and compared between pregnant and nonpregnant women using logistic regression analysis.ResultsA total of 1758 women (pregnant: 43.3%; nonpregnant: 56.6%) were screened in the study over a period of 2 years, out of which 9.3% (163/1758) were having significant bacteriuria. Escherichia coli and Klebsiella pneumoniae were the two commonest uropathogen in both the groups; their prevalence being 83.6% in pregnant women and 85.2% in nonpregnant women, respectively. Resistance against ampicillin, cefixime, cefoxitin, ceftazidime, ceftriaxone and amoxicillin-clavulanic acid were found significantly lower in the pregnant women compared to nonpregnant. After adjusting the age and socio-economic status accounting for centre-to-centre variation, the odds of resistance for cefixime, amoxicillin-clavulanic acid and co-trimoxazole were found lower and statistically significant among the pregnant women group.ConclusionsThe antimicrobial resistance was significantly higher among the community-dwelling nonpregnant women compared to pregnant women in case of few antibiotics. The study highlighted the need of building local antibiogram that could help to initiate the empirical treatment and thus prevent emergence of antimicrobial resistance.

Characterization of virulence factors and antibiotic resistance pattern of uropathogenic Escherichia coli strains in a tertiary care center.

Background: Urinary tract infection(UTI) is one of the commonly prevalent bacterial infection in humans.The uropathogenic E. coli (UPEC) expresses a range of virulence factors that contribute to their pathogenicity . The emergence of multidrug resistance (MDR)-associated UTI is increasing.This study monitors the distribution of virulence factors among UPEC strains to note the antibiogram, outcome and type of associated UTI. Methods:A prospective cross-sectional time-bound study of six months was done on clinically significant urinary isolates of Escherichia coli. Detection of haemolysin production and serum resistance was done by phenotypic methods. Genotypic characterization of the virulence genes ( papC, iutA, hlyA, cnf1) was done by multiplex PCR. Demographic data, clinical history, antibiogram and type of UTI was collected from clinical case records. Results:75 E.coli isolates from patients with suspected UTIs were included. Females had a higher preponderance of UTI (66.7%). 93% of patients were adults and the remaining 7% were from paediatrics. 24 (32%) isolates showed haemolysis by plate haemolysis and all isolates were serum-resistant. Out of 75 isolates, 65 were positive for at least one of four targeted genes, while remaining ten isolates were negative for all four genes.Multidrug resistance was found in 40 (53.3%) isolates. 97.4% of the UTI cases had a favourable clinical outcome at discharge. Mortality due to urosepsis was 2.6%. Conclusion:Association of hemolysin production with resistance to imipenem and norfloxacin in UPEC strains was significant.Presence of hlyA gene is positively associated with ceftazidime resistance. Nitrofurantoin, piperacillin, tazobactam, and cefaperazone sulbactam are possible candidates for empirical therapy of UTIs. Drugs like aminoglycosides, carbapenems and fosfomycin may be used as reserve drugs in the treatment of MDR-UTI.However, inappropriate usage can increase antibiotic resistance. Hence proper selection of antibiotics in hospitals taking into account the local antibiogram is needed to reduce the emergence of antibiotic resistance.

Characterization of virulence factors and antibiotic resistance pattern of uropathogenic Escherichia coli strains in a tertiary care center.

Background: Urinary tract infections (UTI) are the most prevalent bacterial infection in humans. The uropathogenic E. coli (UPEC) expresses a range of virulence factors that contribute to their pathogenicity . The emergence of multidrug resistance (MDR)-associated UTI is increasing. This study monitors the distribution of virulence factors among UPEC strains to note the antibiogram, outcome and type of associated UTI. Methods: A prospective cross-sectional time-bound study of six months was done on clinically significant urinary isolates of Escherichia coli. Detection of haemolysin production and serum resistance was done by phenotypic methods. Genotypic characterization of the virulence genes ( papC, iutA, hlyA, cnf1) was done by multiplex PCR. Demographic data, clinical history, antibiogram and type of UTI was collected from clinical case records. Results:75 E.coli isolates from patients with suspected UTIs were included. Females had a higher preponderance of UTI (66.7%). 93% of patients were adults and the remaining 7% were from paediatrics. 24 (32%) isolates showed haemolysis by plate haemolysis and all isolates were serum-resistant. Out of 75 isolates, 65 were positive for at least one of four targeted genes, while remaining ten isolates were negative for all four genes. Multidrug resistance was found in 40 (53.3%) isolates. 97.4% of the UTI cases had a favourable clinical outcome at discharge. Mortality due to urosepsis was 2.6%. Conclusion: Association of hemolysin production with resistance to imipenem and norfloxacin in UPEC strains was significant. Presence of hlyA gene is positively associated with ceftazidime resistance. Nitrofurantoin, piperacillin, tazobactam, and cefaperazone sulbactam are possible candidates for empirical therapy of UTIs. Drugs like aminoglycosides, carbapenems and fosfomycin may be used as reserve drugs in the treatment of MDR-UTI. However, inappropriate usage can increase antibiotic resistance. Hence proper selection of antibiotics in hospitals taking into account the local antibiogram is needed to reduce the emergence of antibiotic resistance.

Bacterial and Antibiogram Profile of Urinary Tract Infection Patients in Tertiary Hospital, Surabaya, Indonesia

Highlights: Most urinary tract infections are caused by Gram-negative bacteria with E. coli being the most common bacteria. Antibiotics with the highest susceptibility for Gram-negative bacteria were ertapenem, meropenem, amikacin, and imipenem. Antibiotics with the highest susceptibility for Gram-positive bacteria mainly were susceptible to chloramphenicol,streptomycin, vancomycin, rifampin, tigecycline, teicoplanin, and ampicillin. Abstract: Urinary tract infection (UTI) is one of the most common bacterial infections. Inappropriate antibiotic use for UTI treatment may lead to antibiotic resistance. This study aimed to provide an updated bacterial and antibiogram profile from urine specimens of patients diagnosed with UTI. This study was a retrospective study using urine culture and antibiotic susceptibility test results obtained from Clinical Microbiology Laboratory in a tertiary general hospital in Surabaya, Indonesia for a two-month period patients. Most aged more than and/or equal to 59 years, in both sexes. Gram-negative bacteria, particularly , was being the most between June to July 2019. There were 215 patients with significant urine culture results of 54.4% from Escherichia coli female bacteria were carbapenem antibiotics and amikacin, while teicoplanin and vancomycin were some antibiotics susceptible to gramcommon bacteria that caused UTI, followed by K. pneumoniae. Some antibiotics with the highest susceptibility to gram-negative positive bacteria. This study result indicated that there was an urge to conduct local antibiogram profile investigation due to the low susceptibilities shown in recent empirical therapy recommendations, such as trimethoprim sulfamethoxazole, fluoroquinolone, nitrofurantoin, and fosfomycin.

PD21-11 WITHIN STATE VARIABILITY OF ANTIMICROBIAL SUSCEPTIBILITY: MISSOURI AS AN ARCHETYPE TO ASSESS GUIDELINES FOR ANTIMICROBIAL PROPHYLAXIS FOR TRANSURETHRAL PROCEDURES

You have accessJournal of UrologyCME1 May 2022PD21-11 WITHIN STATE VARIABILITY OF ANTIMICROBIAL SUSCEPTIBILITY: MISSOURI AS AN ARCHETYPE TO ASSESS GUIDELINES FOR ANTIMICROBIAL PROPHYLAXIS FOR TRANSURETHRAL PROCEDURES Corbin Wright, Geoffrey Rosen, Shubham Kanake, Mojgan Golzy, and Katie Murray Corbin WrightCorbin Wright More articles by this author , Geoffrey RosenGeoffrey Rosen More articles by this author , Shubham KanakeShubham Kanake More articles by this author , Mojgan GolzyMojgan Golzy More articles by this author , and Katie MurrayKatie Murray More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002559.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The American Urological Association has developed recommendations for antimicrobial prophylaxis for transurethral (TU) procedures. Specific regimens are advised, with the guidance for urologists to check their local antibiograms. Here, we use Missouri to examine the presence and variability in antibiograms within a state, helping to show the ease with which a urologist may consider a local antibiogram. METHODS: All hospitals in the state of Missouri were identified using the American Hospital Directory and contacted to request antibiograms. Hospital characteristics including bed-size, location, and rurality were collected. Based on results of our prior antibiogram work, we studied E. coli, Klebsiella, and Proteus. We evaluated susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX), Third generation cephalosporins, cefazolin, penicillin combinations, gentamicin and fluoroquinolones. We looked at overall variability and looked for association with hospital bed-size, location, and rurality. RESULTS: Eighty-two hospitals were contacted, and data is included from thirty-nine (48% response rate). Susceptibility of relevant microbes to frequently used antimicrobials is displayed in Table 1. The only statistically significant correlation between hospital characteristics and susceptibility was between increased hospital bed-size and E. coli resistance to penicillin combinations (P=0.001; R-squared=0.47). CONCLUSIONS: Prior work has shown low susceptibility of common infectious agents after TU procedures to first-line recommended prophylactic antimicrobials. Here, we apply similar methods to a study of hospitals in Missouri. First-line recommendations have low coverage, 82% mean susceptibility for E. coli for 1st generation cephalosporins and 78% for TMP-SMX. Third generation cephalosporins showed high susceptibilities, as did gentamicin. Current recommendations for TU prophylaxis advise use of local antibiograms, yet we were unable to acquire antibiograms from more than half of contacted hospitals. Urologists should consider local patterns when selecting antimicrobials for TU procedure prophylaxis. If not possible, broader-spectrum antimicrobials than current recommendations may be useful. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e365 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Corbin Wright More articles by this author Geoffrey Rosen More articles by this author Shubham Kanake More articles by this author Mojgan Golzy More articles by this author Katie Murray More articles by this author Expand All Advertisement PDF DownloadLoading ...

Bacteriological profile and antibiogram analysis from a tertiary care centre in eastern India: Time to Act / ReAct

Development of antimicrobial resistance imposes a serious threat to the timely and efficient healing of mankind who fall prey to the infectious agents. It is increasingly being reported day by day throughout the world. Irrational and overuse of antibiotics coupled with unavailability of regional or local antibiogram aggravates the situation further.To understand and present the local antbiogram data for this region and bridge the existing knowledge gap about the same for this particular region.Two year data was retrospectively analyzed from a 750 bedded tertiary care centre.A total of 1143 non repeat isolates were studied, their antibiogram profiles were analyzed. Percentage of Gram negative bacteria obtained were 59.6%, while Gram Positive bacteria were obtained in 40.4% of the isolates. (22.8%) was the most common organism isolated, followed by Staphylococcus aureus (14.2%), Other sp(12.8%), sp(12.6%), (9.4%), and complex(7.4%), Miscellaneous Bacteria(13.4%). An alarming number of isolates were found to be Multidrug resistant isolates(MDRs). With the panel of antibiotics tested for Gram negative bacterial isolates, only Fosfomycin(1.5%), Nitrofurantoin(16%) &amp; Chloramphenicol (19%) were the only antibiotics to exhibit &amp;#60;20% resistance. Antibiotics for Gram positive bacteria for which low resistance was observed were Vancomycin (0%), Linezolid (0.1%), Teicoplanin (&amp;#60;1%), Aminoglycosides (18%), Nitrofurantoin(15%), Chloramphenicol(6%) &amp; Tetracyclines(11%). Extended Spectrum Beta lactamase(ESBL) prevalence was estimated to be 63.6% in , 82.4% in Klebsiellapneumoniae. Methicillin resistant Staphylococcus aureus (MRSA) was seen in 54% of the isolates, while Inducible clindamycin resistance was observed in 35.9% of the isolates.It is high time that we shift our focus from internationally and nationally available data on antibiogram to locally prevalent antibiotic resistance pattern. It will ensure faster patient recovery at a lesser cost and also prevent undue development of drug resistance.

Bacteriology and Antibiotic Sensitivity Pattern of Isolates in Patients who Underwent Percutaneous Nephrolithotripsy (PCNL) at the Philippine General Hospital: A Retrospective Cohort Study

Background. Despite being a clean-contaminated procedure, performed only in patients with sterile urine preoperatively, percutaneous nephrolithotripsy (PCNL) is associated with significant infectious perioperative complications. A local antibiogram is of paramount importance in optimizing antibiotic prophylaxis in PCNL because of the substantial variation in bacterial distribution and antibiotic sensitivity worldwide.&#x0D; Objectives. The incidence of post-PCNL infectious complications, microorganism distribution, and antibiotic sensitivities from patients admitted for PCNL was determined. The risk factors associated with positive cultures and the development of fever and bacteremia were also analyzed.&#x0D; Methods. A retrospective study of 102 patients who underwent PCNL under a surveillance protocol was done. The susceptibility of isolates from different specimens was evaluated against the most common antibiotics in the hospital. Chi-square and Student’s t-test were used to determine differences in the frequencies and means for other risk factors for those who developed fever and urosepsis and those who did not.&#x0D; Results. The incidence of fever and urosepsis was 25% and 4%, respectively. The most common organism on urine specimens was Escherichia coli which showed high sensitivity to aminoglycosides. The most common isolate on stones was Pseudomonas aeruginosa, which showed higher sensitivities to the fluoroquinolones. The isolates showed nearly consistent resistance to ceftriaxone. No significant association was found between the clinical variables studied and the occurrence of infectious complications.&#x0D; Conclusion. There are comparable rates of infectious complications to published literature. A change in antibiotic prophylaxis was warranted, given the high resistance to ceftriaxone and the predominance of Pseudomonas aeruginosa on stone isolates. Further surveillance is required to identify significant risk factors for the development of post-PCNL infectious complications.

Preventing Potentially Inappropriate Use of Antibiotics Using the World Health Organization AWaRe Tool

Background To avert the rise in antimicrobial resistance, the World Health Organization (WHO) introduced the AWaRe (Access, Watch, Reserve) tool to its Essential Medicines List in 2017. In India, only few studies analyzing the antibiotic prescribing pattern according to AWaRe tool were conducted, most of which included data from wholesale databases. Aim This study was aimed at analyzing the antibiotic prescriptions in the outpatient (OP) clinic of a quaternary care hospital as per the WHO AWaRe tool. Method This observational study collected the details of patients who received at least 1 oral/intravenous antibiotic and visited the OP clinic during August 2018 to August 2019. The data were collected from electronic medical record, and it included patient demographics, department, and name of antibiotics prescribed. The proportion of antibiotic use was measured as per WHO AWaRE tool. Results A total of 23,088 antibiotic prescriptions were collected from 58 departments. It was found that 41.32% of antibiotics were from the Access group, whereas 51.01% were from the Watch group and 1.19% from the Reserve group. Amoxicillin-clavulanic acid (Access), azithromycin (Watch), and linezolid (Reserve) were the commonly prescribed antibiotics in the OP department. Conclusions Considering the overall use, the Watch group antibiotics were used to a great extent compared with that of the Access antibiotics, which contradicts the recommended WHO AWaRe criteria. This simple and easy-to-apply antibiotic use monitoring tool, “AWaRe,” must be aligned with the local antibiogram to serve the patient best.

A Systematic Review of Multi-decade Antibiotic Resistance Data for Ocular Bacterial Pathogens in the United States.

IntroductionSince 2009, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study has been assessing in vitro antibiotic resistance for bacterial isolates sourced from ocular infections in the US. The main goal of this systematic review was to compare in vitro resistance data for ocular pathogens from published US studies with the most recently published data from the ARMOR study (2009–2018) and, where possible, to evaluate trends in bacterial resistance over time over all studies.MethodsA literature search was conducted using MEDLINE®, BIOSIS Previews®, and EMBASE® databases (1/1/1995–6/30/2021). Data were extracted from relevant studies and antibiotic susceptibility rates for common ocular pathogens (Staphylococcus aureus, coagulase-negative staphylococci [CoNS], Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae), longitudinal changes in susceptibility, and multidrug resistance (MDR) were compared descriptively.ResultsThirty-two relevant studies were identified. High in vitro resistance was found among S. aureus and CoNS to fluoroquinolones, macrolides, and methicillin/oxacillin across studies, with high rates of MDR noted, specifically among methicillin-resistant staphylococci. Data from studies pre-dating or overlapping the early years of ARMOR reflected increasing rates of S. aureus resistance to fluoroquinolones, macrolides, methicillin/oxacillin, and aminoglycosides, while the ARMOR data suggested slight decreases in resistance to these classes between 2009 and 2018. Overall, methicillin-resistant S. aureus (MRSA) prevalence peaked from 2005 to 2015 with a possible decreasing trend in more recent years.Discussion and ConclusionsData from local and regional US datasets were generally consistent with data from the national ARMOR surveillance study. Continued surveillance of ocular bacterial pathogens is needed to track trends such as methicillin resistance and MDR prevalence and any new emerging antibiotic resistance phenotypes. Susceptibility data from ARMOR can inform initial choice of therapy, especially in practice areas where local antibiograms are unavailable.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00449-9.

Etiology and Antibiotic Susceptibility Patterns of Urinary Tract Infections in Children in a General Hospital in Kuwait: A 5-Year Retrospective Study

Objective: The aim of this study was to determine the bacterial profile and prevalence of antibiotic resistance patterns of uropathogens, as well as to evaluate the problem with extended-spectrum β-lactamases (ESBLs)-producing isolates, causing urinary tract infections (UTIs) in children in Al-Amiri Hospital, Kuwait, over a 5-year period. Materials and Methods: Significant isolates from symptomatic pediatric patients with UTIs from January 2017 to December 2021 were identified by conventional methods and by the VITEK 2 identification card system. Antimicrobial susceptibility testing was performed by the disk diffusion method for Gram-positive organisms and an automated VITEK 2 system for Gram-negative organisms. ESBL-producing Enterobacterales were detected by the double-disk diffusion method and VITEK 2 system. Results: Significant bacteriuria was detected in 13.7% of the 9,742 urine samples. Escherichia coli accounted for 67.3% of these, followed by Klebsiella pneumoniae (8.9%), Proteus spp. (5.7%), and Enterococcus spp. (7.4%), respectively. High resistance rates were observed among the Enterobacterales against ampicillin, cephalothin, nitrofurantoin, amoxicillin/clavulanic acid, and trimethoprim-sulfamethoxazole. The prevalence of ESBL-producing E. coli and K. pneumoniae was 26% and 55%, respectively. The most sensitive among the antibiotics tested for Gram-negative organisms were meropenem, amikacin, gentamicin, and piperacillin/tazobactam, while the antibiotics tested for Gram-positive organisms were vancomycin, ampicillin, linezolid, and nitrofurantoin. Conclusion: E. coli remains the most common uropathogen. A high percentage of uropathogens causing UTI in children were highly resistant to the first- and second-line antibiotics for the therapy of UTI. ESBL-producing bacteria were highly prevalent in children in our hospital. Local antibiograms should be used to assist with empirical UTI treatment.

THE USE OF MICROBIOLOGICAL AND LABORATORY DATA IN THE CHOICE OF EMPIRICAL ANTIBIOTIC THERAPY IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY - THE ROLE OF LOCAL ANTIBIOGRAMS.

Antibiotic therapy is indicated during acute cholecystitis. However, in the treatment of uncomplicated cholelithiasis, prophylactic use of antibiotics is controversial. Microbiological and laboratory data are the basis for the choice of antibiotic treatment. However, monitoring and updating local antibiograms is important because they ensure effective therapy in the given clinical environment. The study included 110 consecutive patients who underwent laparoscopic cholecystectomy, divided into the group of uncomplicated cholelithiasis (n=60) and the group of acute cholecystitis (n=50). Preoperative data included age, sex, body mass index, leukocytes, C-reactive protein, and ultrasound examination. Bile samples for bacteriological testing were obtained under aseptic conditions during the surgery. Cultures were evaluated for aerobic, anaerobic and fungal organisms using routine tests. After the surgery, gallbladder specimens were sent for histopathological examination. In the group of uncomplicated cholelithiasis, 6/60 positive samples were found, and in the group of acute cholecystitis, there were 25/50 positive microbiological findings. Citrobacter sp. and Enterococcus faecalis predominated in the group of uncomplicated cholelithiasis, and Escherichia coli, Enterococcus faecalis, Proteus mirabilis and Citrobacter sp. in the group of acute cholecystitis. Antibiotics were administered to 49/50 patients with acute cholecystitis and to 32/60 patients with uncomplicated cholelithiasis. Cefazolin was the most frequently used antibiotic and also the most resistant antibiotic. To conclude, the administration of antibiotics in elective patients is not justified. The results of this study indicate that third-generation cephalosporin or ciprofloxacin + metronidazole should be administered in mild and moderate acute cholecystitis, and fourth-generation cephalosporin + metronidazole in severe acute cholecystitis in this local setting. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.

Antimicrobial resistant Shigella in North India since the turn of the 21st century

PurposeThe ubiquitous presence and rampant spread of antibiotic resistant strains of Shigella spp is a major public health concern. Therefore, monitoring the trends of antimicrobial resistance in them is essential. MethodsA total of 15440 stool samples were inoculated on MacConkey agar, lysine deoxycholate agar and Selenite F enrichment broth from 2001 to 2015.Out of 491 shigellae isolated, 250 isolates were recovered from our culture collection. Antimicrobial susceptibility was performed by Kirby Bauer disc diffusion method, E-test and phenotypic resistance screening for ESBL and AmpC production was performed. For the detection of beta-lactamase genes, PCR for blaTEM, blaSHV, blaOXA, blaCTX-M-15, CMY-2 and mphA PCR in isolates with decreased susceptibility to azithromycin(DSA) was performed. ResultsS. flexneri (n ​= ​173) was most common, followed by S.dysenteriae (n ​= ​24), S.sonnei (n ​= ​23), S.boydii (n ​= ​10) and Non agglutinating Shigella (NAG, n ​= ​20). A see-saw pattern in the prevalence of S. flexneri and S. dysenteriae and rising prevalence of S. sonnei and NAG was seen. Majority (77%) of the isolates had MICs >4 ​mg/L for ciprofloxacin and >50% had high MIC90 (12 ​mg/L) for ceftriaxone and cefepime (8 ​mg/L). Nearly 20% of S.flexneri were resistant to third generation cephalosporin by disc diffusion and 33.7% had MIC ≥1 ​μg/mL. Among the ceftriaxone resistant isolates (n ​= ​29) the blaTEM beta-lactamase resistance gene was seen in all, blaCTX-M-15 in 37%, blaCMY-2 in 45.6% and blaOXA in 52%. The first report of DSA at our institute was in 2001 (n ​= ​1, 2.5%) which increased to 35.1% (n ​= ​40) in 2011–15. The isolates with DSA included S. flexneri (n ​= ​40), S. boydii (n ​= ​4) and S. sonnei (n ​= ​1) and plasmid mediated resistance to azithromycin by mphA gene was detected in 19 out of 40 isolates of S. flexneri. ConclusionGlobal emergence of resistance Shigella is a matter of concern and calls for systematic monitoring and periodic updates of countrywide and local antibiogram.