Evaluating Multidrug Resistance Prevalence and Antimicrobial Stewardship Preparedness in the Largest Not-For-Profit Healthcare System in the United States: Taking the First Step to Optimize Antimicrobial Use
Methods: A survey from 85 hospitals of a single healthcare system evaluated the prevalence of MDROs, and the presence of antimicrobial stewardship programs (ASPs). Questions addressed the prevalence of MDROs and local measures to optimize antimicrobial use. We compared the results based on hospital bed size (small ≤200, medium 201-500, large >500 beds).
Results: Larger hospitals had the highest reported rates of Klebsiella pneumoniae carbapenem resistant organisms (2.2% vs. 0.7% for medium and 0.3% for small; p=0.001). Medium size hospitals reported higher rates of carbapenem resistant to Escherichia coli (0.091% vs. 0.018% for large and 0.015% for small; p=0.09). There were no significant differences for extended spectrum beta lactamase producing E. coli (large 4.6%; medium 4.9%; small 7.9%; p=0.51). The vast majority of hospitals (n=81, 95.3%) produced an antibiogram, with 77 (90.6%) at least annually. ASPs were more established in large (100%) and medium (81.5%) compared to small (23.1%) hospitals (p<0.001). Large hospitals more often restricted broad-spectrum antimicrobials (83.3% vs. 63% for medium and 23% for small; p<0.001). Prospective evaluation by pharmacists was 100% in large hospitals (44.4% for medium and 25% for small; p=0.001). Mandatory Infectious Diseases consultation for specific broad-spectrum agents was more common in large (100%) compared to medium (40.7%) and small (9.6%; p=<0.001). Clinical pathways for specific infections were more common among large hospitals (66.7% vs. 40.7% for medium and 21.2% for small; p=0.001). Infectious Diseases pharmacist approval was rarely used.
Conclusion: The prevalence of MDROs and the presence of ASPs vary based on hospital size. Smaller hospitals may be less prepared than larger ones to address antimicrobial stewardship. Our findings contribute to a better understanding of the varied needs of our hospitals to develop future processes and optimize patient care outcome.
G. Fraine, None
M. Heavens, None
A. Hendrich, None