1788. Distribution of Gram-Negative (GN) Pathogens and Carbapenem Resistance (CR) Patterns across United States Hospitals: Will Klebsiella become the new Pseudomonas?
Session: Poster Abstract Session: Resistant Gram-Negative Infections: CRE Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Distribution of Gram-Negative (GN) Pathogens and Carbapenem Resistance (CR) Patterns across United States Hospitals.pdf.pdf (449.2 kB)
  • Background:

    Data from national surveillance programs define antibiotic resistance trends.  Nationwide SUR data are limited by (1) low participation & geographic sampling, (2) small number of isolates from participating centers, and (3) failure to include carbapenem-resistant Enterobacteriaceae (CRE), Pseudomonas (CRP), & Acinetobacter (CRAB). Given critical public health concerns, our study objective was to define patterns of CR among key pathogens in US hospitals. 

    Methods:

    Nationwide survey of GN pathogens and CR patterns was compiled from the 2013 calendar year antibiograms of 50 US hospitals. CR was defined as non-susceptibility to meropenem or imipenem. Prevalence and CR was examined by geographic region, bed size, teaching status, length of stay (LOS), Case Mix Index, and stratified by GN pathogen. 

    Results:

    94,887 GN clinical isolates were reported.  E.coli & Klebsiella spp. were the most common. CR among key GN pathogens ranged from <1% (CR-E.coli) to >44% (CRAB). The overall prevalence of CR was 8%. There was significant variation of CR among all reported GN pathogens by geographic region, bed size, teaching status, and LOS. CR varied significantly for both Klebseilla and Enterobacter by geographic regions and CR-E.coli varied significantly by bed size. Results differed for urine and non-urine isolates.

    Distribution of GN pathogens & CR resistance among isolates from any source

     

    CR-GNR

    CRP

    CR-Klebseilla

    CR-Enterobacter

    CRAB

    CR-E.Coli

    CR isolates/total isolates

    7283/94887

    2614/13716

    609/13849

    140/4014

    725/1610

    237/48242

    Region

    East

    12%*

    20%

    7%*

    8%*

    34%

    <1%

    Central

    4%*

    17%

    <1%*

    1%*

    40%

    <1%

    Mountain

    6%*

    13%

    <1%*

    1%*

    32%

    <1%

    Pacific

    6%*

    16%

    2%*

    2%*

    40%

    1%

    Bed #

    < 150

    5%*

    17%

    2%

    3%

    44%

    <1%*

    > 150 X < 400

    10%*

    14%

    4%

    7%

    24%

    <1%*

    ≥ 400

    14%*

    21%

    6%

    3%

    38%

    1%*

    Teaching

    Y

    14%*

    21%*

    7%*

    8%*

    40%

    <1%

    N

    4%*

    14%*

    1%*

    1%*

    26%

    <1%

    LOS

    ≤ 4.8

    7%*

    16%

    4%

    5%

    31%

    <1%

    > 4.8

    12%*

    20%

    5%

    5%

    36%

    <1%

    Case Mix

     ≤ 1.57

     8%

    16%

    4%

    5%

    35%

    <1%

    >1 .57

    10%

    18%

    3%

    4%

    32%

    <1%

    * = p<0.05

     

    Conclusion:

    With rising incidence of CR, there is a need for SUR at national, regional & hospital levels. Our findings highlight the importance of local decision support tools to identify patients at high risk for CR. These data are crucial for selecting appropriate empirical treatment while awaiting susceptibility results. 

    James a. Mckinnell, MD1, Margaret Griffin, MPH2, Romney Humphries, Ph.D.3, Janet Hindler, MCLS, MT(ASCP)3, Olga Crowley, PhD2, Shanice Bedassie, .2, Kayla Stephenson, .2, Charlie Garland, MBA2 and Thomas Lodise, PharmD, PhD4, (1)Torrance Memorial Medical Center, Torrance, CA, (2)HITLAB, New York, NY, (3)Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA, (4)Albany College of Pharmacy, Albany, NY

    Disclosures:

    J. A. Mckinnell, Actavis: Consultant , Consulting fee

    M. Griffin, Actavis: Research Contractor , Research grant

    R. Humphries, None

    J. Hindler, None

    O. Crowley, Actavis: Research Contractor , Research grant

    S. Bedassie, Actavis: Research Contractor , Research grant

    K. Stephenson, Actavis: Research Contractor , Research support

    C. Garland, Actavis: Research Contractor , Research grant

    T. Lodise, Actavis: Consultant , Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.