709. The Regional Antibiogram Is an Important Public Health Tool to Improve Empiric Antibiotic Selection, Stenotrophomonas maltophilia  As A Case Example
Session: Poster Abstract Session: Stewardship: Program Implementation
Thursday, October 5, 2017
Room: Poster Hall CD

Background: Early appropriate antibiotic selection is life saving in sepsis. Facility-level antibiograms inform antibiotic selection after pathogen identification and before susceptibility results are available, but only if ≥ 30 isolates from a given species are tested in the prior year. Stenotrophomonas maltophilia (SM) has a complex resistance profile and is associated with an 8-fold mortality increase. We hypothesized that a regional antibiogram may help inform clinical decision making for severe SM infections.

Methods: To generate a regional SM antibiogram, we conducted a cross sectional, voluntary survey of 2015 cumulative facility-level antibiograms from all hospitals in LA county. Non-respondents were contacted to improve response rates. Isolates from sterile sources were pooled. Susceptibility was aggregated and percent susceptible was calculated only when all isolates were tested, i.e. not reflex testing. To identify optimal combination empiric therapy for SM infections, we generated a combination antibiogram using broth microdilution results from a single tertiary care facility in LA.

Results: Antibiograms were submitted by 85/100 (85%); 50 hospitals (59%) reported SM (n=1719 isolates, Table 1). Hospitals  commonly (25/50) reported data for <30 isolates. The combination antibiogram for SM is presented in table 2. Four hospitals reported susceptible results for antibiotics to which SM is intrinsically resistant (ceftriaxone, meropenem, aminoglycosides). After SXT, the most active antibiotics against SM were not routinely tested by the majority of laboratories (minocycline, colistin) (Table 2).

Conclusion: The LAC regional antibiogram represents one of the largest reports of SM susceptibility presented to date. Hospitals rarely tested sufficient numbers of SM isolates to provide reliable estimates for resistance and failed to report on clinically valuable treatment options.  Regional antibiograms may help hospitals with low pathogen prevalence improve antibiotic selection and reduce mortality for uncommon but potentially deadly pathogens.


Romney Humphries, PhD1, Job Mendez, RN, MD2, Loren Miller, MD, MPH, FIDSA2, Aaron Miner, BA3, Priyanka Fernandes, MBBS, MPH4, Stefan Richter, MD5, Ryan Franco, BS2, Joanna Felix-Mendez, HSDG3, Shalini Agrawal, BS2, Jacob Sinkowitz, HSD2, Deren Sinkowitz, MD5, Christina Hershey, BA6, Nanruoyi Zhou, BA3, Alyssa Eliopulos, HSDG3, Sandeep Bhaurla, MPH, CIC7, Aldon Mendez, BS3, Patricia Marquez, MPH, CIC8, Shiva Niakan, BS3, Dawn Terashita, MD, MPH7, Benjamin Schwartz, MD8 and James A. McKinnell, MD2,9,10,11, (1)Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, (2)Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, (3)Infectious Disease, LA BioMed Research Institute at Harbor-UCLA, Torrance, CA, (4)University of California Los Angeles, Westwood, CA, (5)David Geffen School of Medicine, Los Angeles, CA, (6)UCLA, Los Angeles, CA, (7)Department of Public Health, Los Angeles County, Los Angeles, CA, (8)Los Angeles County Department of Public Health, Los Angeles, CA, (9)David Geffen School of Medicine at UCLA, Torrance, CA, (10)Los Angeles County Department of Public Health, Healthcare Outreach Unit (HOU), Los Angeles, CA, (11)Expert Stewardship, LLC, Newport Beach, CA

Disclosures:

R. Humphries, None

J. Mendez, None

L. Miller, Sage Products: Study coordination , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Study coordination , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Study coordination , Conducting studies in healthcare facilities that are receiving contributed product
3M: Study coordination , Conducting studies in healthcare facilities that are receiving contributed product

A. Miner, None

P. Fernandes, None

S. Richter, None

R. Franco, None

J. Felix-Mendez, None

S. Agrawal, None

J. Sinkowitz, None

D. Sinkowitz, None

C. Hershey, None

N. Zhou, None

A. Eliopulos, None

S. Bhaurla, None

A. Mendez, None

P. Marquez, None

S. Niakan, None

D. Terashita, None

B. Schwartz, None

J. A. McKinnell, Allergan: Research Contractor , Scientific Advisor and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium
Achaogen: Research Contractor , Scientific Advisor and Shareholder , Research support
Cempra: Research Contractor and Scientific Advisor , Research support
Theravance: Research Contractor , Research support
Science 37: Research Contractor , Salary
Expert Stewardship, LLC: Board Member and Employee , Salary
Thermo Fisher: Scientific Advisor , Salary

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.