970. The Microbiology Laboratory is a Valuable, but Largely Underutilized Partner in Antimicrobial Stewardship and Antimicrobial Resistance Monitoring
Session: Poster Abstract Session: Antibiotic Stewardship: General Acute Care Implementation and Outcomes
Friday, October 28, 2016
Room: Poster Hall
Posters
  • AS IDWEEK 2016 for printing.ppt.pdf (1.1 MB)
  • Background:

    Recent IDSA guidelines for Antibiotic Stewardship Programs (ASPs) recommend working with the microbiology laboratory to develop stratified antibiograms that allow tailored empiric therapy recommendations for different patient populations, and to perform selective reporting of certain antibiotic susceptibility results to encourage narrower therapy. We surveyed California hospital microbiology laboratories for capabilities and practices related to antibiograms and selective reporting.

    Methods:

    The California Antimicrobial Resistance Laboratory Network Assessment (CARLA) was a cross-sectional, voluntary survey targeted to microbiology staff among acute care hospitals in California. Non-respondents were contacted by phone to improve response rates. Respondents were asked to characterize the development of antibiograms and selective reporting practices at their hospital. Hospital beds and patient volume data were obtained from the National Healthcare Safety Network 2015 Annual Survey.

    Results:

    CARLA included 264 (67%) hospitals; representing 75% of hospital beds in California. Respondents were directors n=165, clinical scientists n=97, and infection preventionists n=2. Among 224 (85%) hospitals with laboratory capability to selectively report susceptibility results, 99 (38%) suppress carbapenem results for E. coli susceptible to ceftriaxone, 56 (21%) for P. aeruginosa susceptible to cefepime/ceftazidime/pipercillin-tazobactam, and 50 (19%) for Acinetobacter spp. susceptible to ceftazidime. Among 182 (69%) with access to carbapenemase tests, 80 (44%) edit all β-lactam results to resistant if a carbapenemase is detected. Ninety-eight (37%) hospitals develop population-specific antibiograms, including inpatient vs. outpatient and ICU vs. Ward; 101 (38%) create source-specific antibiograms, including urine (n=90), blood (n=29), and respiratory (n=10).

    Conclusion:

    Microbiology laboratories can play an important role in ASPs. The majority of California hospitals have access to laboratories with selective reporting capabilities, and their ASP should consider incorporating this practice. Similarly, ASPs can further engage their microbiology labs to produce stratified antibiograms.

    James a. Mckinnell, MD1, Erin Epson, MD2, Sam Horwich-Scholefield, MPH, CIC2, Romney Humphries, PhD3, Janet Hindler, MCLS, MT(ASCP)3, Loren Miller, MD, MPH1, Job Mendez, RN, MD1, Dawn Terashita, MD, MPH4, Patricia Marquez, MPH, CIC4, Sandeep Bhaurla, MPH4, Christina Hershey, BA5, Jeremias Martinez, BS1, Marcelo Moran, MA, MPH4, Lindsey Pandes, MPH4 and Lauri Thrupp, MD, FIDSA, FSHEA6, (1)Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, (2)Healthcare-Associated Infections Program, California Department of Public Health, Richmond, CA, (3)Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA, (4)Los Angeles County Department of Public Health, Los Angeles, CA, (5)UCLA, Los Angeles, CA, (6)Medicine, University of California Irvine Health, Orange, CA

    Disclosures:

    J. A. Mckinnell, None

    E. Epson, None

    S. Horwich-Scholefield, None

    R. Humphries, None

    J. Hindler, None

    L. Miller, None

    J. Mendez, None

    D. Terashita, None

    P. Marquez, None

    S. Bhaurla, None

    C. Hershey, None

    J. Martinez, None

    M. Moran, None

    L. Pandes, None

    L. Thrupp, 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.