1917. Trend in Resistant Gram Negative Organisms in Children: Role of an Antimicrobial Stewardship Program
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Trend in Resistant GN Organisms in Children Poster (Lyles).pdf (662.3 kB)
  • Background: Antimicrobial resistance (AMR) is a concerning reality in children. In 2010 Children’s National (CN) instituted a prospective, targeted, audit-based antimicrobial stewardship program (ASP) with focuses within critical care (CC) and hematology/oncology (HO) units. This study evaluated the efficacy of the ASP focusing on WHO gram negative rod (GNR) priority pathogens.

    Methods: This is a retrospective study (2008-2014) utilizing CN antibiograms to analyze the susceptibility trends of K. pneumoniae and P. aeruginosa and pharmacy individual antibiotic dispensing data measured as grams/year. DOT not used because this study is not comparing inter-antibiotic usage. Meropenem (MRP) was targeted for intervention while ceftazidime (CTZ) was used as control.

    Results: By 2010, the susceptibility of K. pneumoniae (n=1214) to MRP and CTZ was 93% and 85% respectively, and by 2014 both had recovered to 99% and 94% respectively (graph 1). The susceptibility of P. aeruginosa (n=2433) also declined prior to ASP institution. MRP fell to 72% in 2009 while CTZ hit 70% in 2012, and by 2014 both had recovered to 90% and 81% respectively (see graph 2). Of note the case mix of patients did not change.

    Prescribing trends reveal the amount of MRP dispensed decreased by 25% hospital-wide with major reductions by HO (48%) over the course of the study period (table 1).  CTZ use decreased by 8% hospital-wide from 2009 (table 2).

    Conclusion: Due to growing resistance in multiple GNR at CN, MRP and CTZ used as prime examples demonstrating partial or full recovery of the susceptibilities of K. pneumoniae and P. aeruginosa by 2014. Prescription pattern analysis reveals significant MRP use reduction by HO with no significant change from CC though reduced use throughout the rest of the institution.

    Title: Graph 1: Trend analysis of susceptibilities: K. pneumoniae

     

    Table 1: MRP (grams/year)

     

    2008

    2009

    2010

    2011

    2012

    2013

    2014

    CC

    1745 (24%)

    1175 (18%)

    934 (17%)

    1037 (20%)

    977 (23%)

    1369 (25%)

    1102 (20%)

    HO

    1835 (25%)

    964 (15%)

    413 (8%)

    519 (10%)

    668 (15%)

    63 (1%)

    890 (17%)

    Total

    7179

    6596

    5326

    5364

    4278

    5503

    5358

     

    Table 2: CTZ (grams/year)

     

    2008

    2009

    2010

    2011

    2012

    2013

    2014

    CC

    1091 (11%)

    1916 (14%)

    1359 (11%)

    1763 (13%)

    1877 (16%)

    2299 (19%)

    2410 (18%)

    HO

    5573 (54%)

    6508 (46%)

    5876 (46%)

    5716 (44%)

    5045 (43%)

    5276 (45%)

    5707 (44%)

    Total

    10304

    14108

    12692

    13818

    11643

    11736

    12986

    John Lyles, MD, Benjamin Hammer, PharmD, Victoria Basalyga, PharmD, BCPS, Bryan Stierman, MD, MPH, Joseph Campos, PhD and Nalini Singh, MD, MPH, FIDSA, FSHEA, FPIDS, Children's National Medical Center, Washington, DC

    Disclosures:

    J. Lyles, None

    B. Hammer, None

    V. Basalyga, None

    B. Stierman, None

    J. Campos, None

    N. Singh, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.