National surveillance for multidrug resistant organisms (MDRO) are limited by narrow geographic sampling, few hospitals, and failure to account for local epidemiology. A Los Angeles County (LAC) regional antibiogram was created to inform public health interventions and provide a baseline for susceptibility patterns countywide, including the difference between acute care hospitals (ACH) and long-term acute care hospitals (LTAC).
We conducted a cross sectional, voluntary survey of 2013 cumulative facility-level antibiograms from all hospitals in LAC; 91 ACH and 9 LTACH. Non-respondents were contacted by phone and in person to improve response rates. Isolates from sterile sources were pooled. Susceptibility was aggregated and percent isolates susceptible were calculated. Antibiograms for ACH and LTAC were created. Data on bed size, patient days, teaching status and geographic SPA region were available.
Seventy facilities (70%) submitted an antibiogram, 61/91 (67%) ACH and 9/9 (100%) LTACH, representing 75% ACH patient days (n=3,770,438), 74% beds (n=18,316), 100% LTAC patient days (n=199,795) and 100% beds (n=772). Carbapenem resistant: Klebsiella spp. were 21% (range: 0-77%, n=3,531 resistant isolates) for ACH and 71% (57-88%, n=1,009) for LTAC; Pseudomonas spp. was 30% (0-46%, n=4,859) for ACH and 59% (39-64%, n=971) for LTAC; Acintetobacter spp. was 67% (0-100%, n=1,851) and 87% (82-99%, n=1,180). Vancomycin resistant Enterococcus spp. was 15% (0-82%, n=3,446) in ACH and 65% (8-95%, n=498) in LTAC. Methicillin-resistant Staphylococcus aureus was 39% (0-75%, n=11,426) in ACH and 81% (69-89%, n=821) in LTAC.
This investigation highlights wide MDRO variation across facilities in our region. Providers should make an effort to understand local resistance patterns and resistance patterns of referring institutions to optimize empiric antibiotic selection. These data are relevant for monitoring resistance trends over time and will be used to structure public health interventions. Future regional antibiograms should be based on patient level data, which would allow for development of stratified and combination antibiograms.
P. Marquez, None
A. Flood, None
J. Mendez, None
J. A. Mckinnell, None