365. Regional Difference of Extended-spectrum β-lactamases (ESBLs) Susceptibility in USA Hospitals in 2015 
Session: Poster Abstract Session: HAI: Multi Drug Resistant Gram Negatives
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • BD ESBL ID Week Poster v5 FINAL 10-24-16.pdf (328.1 kB)
  • Background:  We examined the regional differences in susceptibility of ESBLs producing E coli (EC), K pneumoniae (KP), and P mirabilis (PM) isolates in different settings.

    Methods: We analyzed an electronic research dataset of Becton, Dickinson & Company from 346 USA hospitals in 2015. All non-duplicate EC, KP, and PM isolates (first isolate of a species per 30 day period) from all sources were categorized as ESBLs if confirmed as ESBL-positive per commercial panels or intermediate/resistant to either ceftriaxone, cefotaxime, ceftazidime or cefepime. Positive isolates were categorized into 3 settings by the specimen collection time: a) Admission: within 3 days of an inpatient admission and no previous admission within 14 days; b) Hospital-onset: 3 days post-admission or within 14 days of discharge; c) Ambulatory (neither a or b). Geographic regions were classified into NHSN categories (Sievert, 2013). Region 1, 7, & 8 were grouped into “Other” due to small number of hospitals. We conducted pairwise comparisons between regions using the region with the overall lowest ESBL rate as the reference group.

    Results: The overall ESBL rate was 6.9% (56718/820017). The ESBL rates for ambulatory, admission, and hospital-onset settings were 5.7% (36086/631846), 9.2% (9693/105846), and 13.3% (10939/82325), respectively. Compared to Region 10, all regions, except for “Other”, had significantly higher ESBL rates, ranging from 4.4% to 7.9% (all P<0.05) for ambulatory; from 7.8% to 12.6% (all P<0.01) for admission; and 11.0% to 18.7% (all P<0.01) for hospital-onset settings.

    NHSN Region

    States

    # of Hospitals

    % ESBL

    Ambulatory

    Admission

    Hospital

    2

    NJ, NY, PR, VI

    30

    7.1

    12.6

    18.7

    9

    AZ, CA, HI, Pacific Islands

    28

    7.9

    11.5

    16.6

    6

    AR, LA, NM, OK, TX

    59

    6.9

    9.6

    13.4

    4

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

    98

    6.2

    9.2

    13.2

    5

    IL, IN, MI, MN, OH, WI

    85

    4.4

    8.2

    11.5

    3

    DE, DC, MD, PA, VA, WV

    13

    5.2

    7.8

    11.0

    10

    AK, ID, OR, WA

    22

    4.0

    5.5

    8.6

    1, 7, 8

    Other

    11

    4.1

    6.0

    8.0

    Overall

    346

    5.7

    9.2

    13.3

    Conclusion: ESBL rates were highest in the hospital setting with significant regional differences. The highest ESBL region had a rate approximately twice that of the lowest region in all three settings. Regional and setting differences in ESBL epidemiology should be considered when making empiric antibiotic treatment decisions.

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

    Disclosures:

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

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

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

    S. Merchant, Merck & Co. Inc.: Employee , Salary

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

    P. Moise, Merck & Co. Inc.: Employee , Salary

    V. Gupta, 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.