1492. Regional Differences in Carbapenem Non-Susceptibility in US Hospitals in 2015
Session: Poster Abstract Session: HAI: Surveillance and Public Reporting
Friday, October 28, 2016
Room: Poster Hall
Posters
  • McCann.pdf (288.3 kB)
  • Background: Carbapenem non-susceptibility (NS) in Gram-negative (GN) bacteria is recognized as a serious issue in the US, though regional data are limited.

    Methods: Electronic data from a Becton, Dickinson & Company research database for 346 US hospitals were analyzed for the year 2015. All inpatient, non-duplicate GN isolates (first isolate of a species per 30 day period) from all sources (urine, skin, blood, intra-abdominal, respiratory, other), that were reported, were classified as carbapenem NS if intermediate or resistant to: a) imipenem or meropenem for Pseudomonas aeruginosa(PsA) or b) imipenem, meropenem, or ertapenem for Enterobacteriaceae. Geographic regions were as per National Healthcare Safety Network categories (Sievert 2013, ICHE). Regions 1, 7, and 8 were grouped as "other" due to the low number of hospitals (n=11). Pairwise comparisons between regions used the region with the lowest NS rate as the reference group.

    Results: PsA, Klebsiella pneumoniae (KP), and Escherichia coli (EC) comprised the majority of tested isolates (162,710/206,907). The highest NS rates were in PsA, ranging from 10.2% (region 10) to 29.2% (region 2) (all regions 22.4%). KP NS rates ranged from 0.4% (“other”) to 16.8% (region 2) (all regions 5.4%). EC isolates were the most numerous though NS rates were low: 0.3% (range 0.1% – 0.4%).

    US region (hospitals, n)

    States/territories

    Most frequent isolates

    P. aeruginosa

    K. pneumoniae

    E. coli

    Isolates, n

    NS rate, %

    Isolates, n

    NS rate, %

    Isolates, n

    NS rate, %

    2 (30)

    NJ, NY, PR, VI

    4095

    29.2

    3075

    16.8

    7727

    0.4

    3 (13)

    DE, DC, MD, PA, VA, WV

    1059

    23.0

    889

    7.8

    2615

    0.2

    4 (98)

    AL, FL, GA, KY, MS, NC, SC, TN

    11,681

    20.9

    10,373

    2.6

    27,347

    0.3

    5 (85)

    IL, IN, MI, MN, OH, WI

    8807

    22.4

    8365

    7.5

    24,624

    0.3

    6 (59)

    AR, LA, NM, OK, TX

    5699

    21.8

    5644

    2.0

    16,925

    0.2

    9 (28)

    AZ, CA, HI, Pacific Islands

    3530

    24.9

    2576

    6.5

    8329

    0.4

    10 (22)

    AK, ID, OR, WA

    699

    10.2

    757

    0.8

    2985

    0.1

    Other

    1, 7, 8 (11)

    All other

    1006

    16.9

    909

    0.4

    2994

    0.2

    All regions (346)

    36,576

    22.4

    32,588

    5.4

    93,546

    0.3

    Conclusion: Carbapenem NS is primarily observed in PsA in US hospitals. Of the most common Enterobacteriaceae, KP has the highest rates of NS. Regional differences are considerable; accordingly, clinicians should be aware of their local antibiogram and reporting patterns when creating treatment protocols.

    Eilish Mccann, PhD1, Vikas Gupta, Pharm.D., BCPS2, C. Andrew Deryke, PharmD1, Richard S. Johannes, MD, MS2,3, Daryl D. Depestel, PharmD, BCPS-ID1 and Ying P. Tabak, PhD2, (1)Merck & Co. Inc., Kenilworth, NJ, (2)Becton, Dickinson and Company, Franklin Lakes, NJ, (3)Harvard Medical School, Boston, MA

    Disclosures:

    E. Mccann, Merck: Employee , Salary

    V. Gupta, Becton Dickinson: Employee , Salary

    C. A. Deryke, Merck & Co. Inc.: Employee , Salary

    R. S. Johannes, Becton Dickinson: Employee , Salary

    D. D. Depestel, Merck & Co. Inc.: Employee , Salary

    Y. P. Tabak, Becton Dickinson: Employee , Salary

    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.