Program Schedule

151
Is Nursing Home Specific Antibiogram Necessary for All Nursing Homes?

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Smaller sample size in nursing homes can be one of the limitations in developing useful facility specific antibiogram. Studies looking into variability of antibiotic susceptibilities for closely located nursing homes are lacking. We examined the differences in the susceptibility results of the commonly prescribed antibiotics for the most common organism identified on urine cultures in 4 different nursing homes located within 5 miles of each other. 

Methods: Using a retrospective study design, we collected susceptibility results of all positive urine cultures sent to Vidant Medical Center microbiology laboratory from 4 closely located nursing homes during the calendar year of 2012. Positive culture results lacking definitive identification or antibiotic susceptibility of microorganisms were excluded. Susceptibility results for commonly used antibiotics were compared for statistically significant differences in the most commonly identified organism among 4 nursing homes using Fisher’s exact test.

Results: Escherichia coli was the most common microorganism from urine cultures with 99 total isolates (21, 23, 19 and 36 from nursing homes A, B, C and D, respectively). When comparing sensitivities of Escherichia coli in nursing homes A, B, C and D, 86%, 78%, 63% and 81% of the isolates were sensitive to trimethoprim-sulfamethoxazole, respectively (p=0.35); 76%, 78%, 58% and 61% to ciprofloxacin (p=0.33), 90%, 87%, 89% and 81% to cefazolin (p=0.69); 95%, 96%, 95% and 100% to nitrofurantoin (p=0.68). The only significant difference was in the sensitivity of ampicillin (62%, 39%, 11% and 44%, p=0.01).  Other common organisms included Klebsiella pneumoniae (n=38), Enterococcus species (n=36), Proteus mirabilis (n= 34), and Pseudomonas aeruginosa (n=22). The number of organisms was too small for statistical analysis for all of these isolates.  

Conclusion:We have demonstrated that antimicrobial susceptibilities were similar for most antibiotics in closely located nursing homes. Antimicrobial stewardship programs can consider developing regional nursing home antibiograms if multiple nursing homes are located in close proximity. This practice can be particularly helpful when developing antibiograms for smaller size nursing homes.

Kaushal Shah, MD1, Paul Cook, MD2, Tae Lee, MD3, Muhammad Salman Ashraf, MD4, John Christie, MD, PhD5 and Xiangming Fang, PhD3, (1)Infectious Disease, East Carolina University/ Vidant Medical Center, Greenville, NC, (2)Infectious Diseases, East Carolina University, Greenville, NC, (3)East Carolina University, Greenville, NC, (4)Infectious Disease, Brody School of Medicine, East Carolina University, Greenville, NC, (5)East Carolina University/ Vidant Medical Center, Greenville, NC

Disclosures:

K. Shah, None

P. Cook, Forest : Paul P. Cook has potential conflicts of interest with Gilead (investigator), Pfizer (investigator), Merck (investigator and speakersí bureau) and Forest (speakersí bureau). and Speaker's Bureau, Speaker honorarium

T. Lee, None

M. S. Ashraf, None

J. Christie, None

X. Fang, None

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