1554. Antifungal Susceptibility Testing Practices at Acute Care Hospitals Enrolled in the National Healthcare Safety Network, United States, 2011─2015
Session: Poster Abstract Session: Mycology: Diagnostic
Friday, October 28, 2016
Room: Poster Hall
  • AFST IDSA poster_Final.pdf (420.2 kB)
  • Background: Echinocandin-resistant Candida bloodstream infections (BSIs) are increasing in the United States. Timely access to antifungal susceptibility test (AFST) results is essential for effective management of these infections; on-site AFST and reflexive susceptibility testing can reduce time to result. We assessed AFST availability and practices reported by short-term acute care hospitals enrolled in the National Healthcare Safety Network (NHSN) during 2011─2015.

    Methods:  We analyzed data from NHSN’s Annual Hospital Survey, including questions regarding hospital characteristics, laboratory capabilities, and AFST practices. McNemar’s test was used to assess changes in these factors for hospitals that reported in both 2011 and 2015; logistic regression was used to model factors affecting AFST.

    Results: Completed surveys were available from 3586 hospitals from both 2011 and 2015. In 2015, 65% of hospitals reported on-site capability for antimicrobial susceptibility testing but only 17% conducted on-site AFST, which was a significant increase from 14% in 2011 (p<0.001). The proportion of facilities with reflexive susceptibility testing for echinocandins increased significantly from 13% in 2011 to 23% in 2015 (p<0.001); reflexive fluconazole susceptibility testing also increased from 24% to 31% (p<0.001) during the same period. Reflexive echinocandin and fluconazole susceptibility testing was more likely to be offered at pediatric hospitals (47% and 55%, respectively) compared with non-specialty general hospitals (22% and 31%, respectively. Among non-specialty general hospitals (74% of all hospitals), having a medical school affiliation and on-site AFST testing were significantly associated with offering reflexive echinocandin susceptibility testing (OR: 1.2 95% CI: 1.0-1.5 and OR: 13.4 95% CI: 10.9-16.6, respectively).

    Conclusion: The proportion of hospitals reporting on-site AFST is low. Reflexive AFST, including testing for echinocandin and fluconazole susceptibility, has increased over the period 2011─2015, but substantial gaps in access remain. As echinocandin resistance continues to rise, improved access to timely AFST will be essential, particularly in hospitals with high rates of Candida BSI.

    Snigdha Vallabhaneni, MD, MPH1, Mathew Sapiano, PhD2, Lindsey Weiner, MPH2, Shawn Lockhart, PhD1 and Shelley S. Magill, MD, PhD2, (1)Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA


    S. Vallabhaneni, None

    M. Sapiano, None

    L. Weiner, None

    S. Lockhart, None

    S. S. Magill, None

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