457. Utility of Computerized Surveillance of Antibiotic Resistance and Usage in an Antimicrobial Stewardship Program
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Rising antibiotic resistance and cost prompted the proposal of antimicrobial stewardship program (ASP) at our centre. Local microbiological and pharmacy data were lacking.
Methods: A computer program extracting daily all positive cultures and dispensed antibiotics from microbiology and pharmacy computer systems was built. Antibiotic resistance and usage, and incidence of antibiotic-resistant bacteria, filtered by disciplines and wards, and effect of antibiotic use on antibiotic-resistant bacteria and antibiogram can be analyzed, and microbiology and pharmacy data readily extracted. Daily alert of antibiotic usage or antibiotic-resistant bacteria exceeding preset threshold is monitored.
Results: Escherichia coli (EC) carried extended-spectrum β-lactamase (ESBL) in 30%, and Klebsiella pneumoniae (KP) 51%. Acinetobacter baumannii (AB) was resistant to imipenem in 71% and Pseudomonas aeruginosa (PA) 18%. From 2006-2008, MRSA rose from 1.3 to 3.0/1000 patient-days (p-d), and carbapenem-resistant AB from 0.4 to 1.1/1000 p-d; ESBL EC and KP, and carbapenem-resistant PA did not rise; and Clostridium difficile decreased from 1.2 to 0.3/1000 p-d. Carbapenem-resistant AB and MRSA were higher in incidence in intensive care units but also disseminated in general wards. Despite stable ESBL EC and KP, ertapenem use rose from 4 to 20 DDD (defined daily dose)/1000 p-d and meropenem from 12 to 28 DDD/1000 p-d from 2007-2008. Piperacillin-tazobactam use rose from 36 to 47 DDD/1000 p-d. Other antibiotic use did not increase, with small decreases in ceftriaxone and ceftazidime use. Audit of carbapenem and piperacillin-tazobactam use showed inappropriate use in 32% and 46% respectively.
Conclusion: Computerized surveillance identified areas of concern in ESBL EC and KP, carbapenem-resistant AB and MRSA, and carbapenem and piperacillin-tazobactam usage. This allows targeted interventions in our ASP, and ability to track effect of ASP interventions on antibiotic resistance and usage.
Brenda Ang, MBBS, M Med, MPH, FAMS1, Prabha Krishnan, MBBS, MRC Path, DTM&H, FRC Path2, Yee-Sin Leo, MBBS3, Wan-Peng Lim, BS3, David Lye, MBBS, Tat-Ming Ng, BS3, Christine Teng, MS3 and  C. Teng, None..
D. Lye, None..
W. Lim, None..
T. Ng, None..
P. Krishnan, None..
B. Ang, None..
Y. Leo, None., (1)Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore, Singapore, (2)Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore, (3)Tan Tock Seng Hospital, Singapore, Singapore