1835. Evaluating Regional Nursing Home Antibiograms to Advance Stewardship at 233 Skilled Nursing Facilities in Georgia, USA
Session: Poster Abstract Session: Antimicrobial Stewardship: Non-hospital Settings
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDWEEK 2018 antibiogram SNF poster v2.pdf (323.9 kB)
  • Background: U.S. skilled nursing facilities (SNFs) must have antibiotic stewardship programs to receive Medicare; this requires access to summary susceptibility data (antibiograms).  Most SNFs test too few clinical samples to generate antibiograms by CLSI standards. We evaluated approaches to combining data across SNFs. 

    Methods: Unsuppressed susceptibility testing results from pathogens recovered from urine specimens submitted in 2015-2016 to a regional referral laboratory servicing SNFs in GA were accessed. Study facilities were limited to GA SNFs (via linkage to CMS nursing home compare). No. and % testing susceptible (no. T, %S) of K. pneumoiae, E. coli, and P. mirabilis to cefazolin, levofloxacin, nitrofurantoin, TMP/Sulfa, and ceftriaxone were pooled overall, by geographic area, year, and other facility-characteristics. P. aeruginosa testing to cefazidime, imipenem, and piperacillin/tazobactam (P/T) were also evaluated. Differences in %S between stratum were considered clinically important if difference were >10 percentage points.

    Results: Of 345 providers, 233 were confirmed as GA SNFs and were categorized by geography as Central (87 SNFs), 8 metro-Atlanta counties (Atlanta Area, 56 SNFs), North (46 SNFs), or Southern (44 SNFs). No. T didn’t vary by year, but varied slightly by region: range for E. coli was 275-1010, K. pneumonia was 101-409, P. mirabilis 133-439, and P. aeruginosa 35-160. No. T was lowest in North and highest in Atlanta Area. Overall %S was poor to levofloxacin, better for TMP/Sulfa and cefazolin (Table).  %S didn’t vary by year. Regional differences were minor: of 17 drug-bug combinations, only 5 has clinically important differences, 3 of which were among P. aeuginosa when testing was limited to 67 isolates in outlier region. Only the South had clinically worse susceptibility of K. pneumoniae to nitrofurantoin (36% vs. 47%).

    Conclusion: Overall, SNFs in Georgia had remarkably similar susceptibility patterns when grouped by geography among common urinary pathogens, except when <75 isolates were tested. Antibiogram data can be combined across facilities in a region to provide SNFs with a reasonable antibiograms for stewardship. Further study is ongoing to assess benefits of bedsize or length of stay based antibiograms.

    Jacob Pack, AS1, Ziduo Zheng, MSc2, Sam Sefton, MPH3, Renee Moore, BS4, Steve Price, ABS1, Mayfield Camp Jr., MS., M(ASCP)1 and Scott Fridkin, MD5, (1)Clinical Laboratory Services, Inc., Winder, GA, (2)Biostatistics and Biofinormatics, Emory University Rollins School of Public Health, atlanta, GA, (3)Emory University, Atlanta, GA, (4)Rollins School of Public Health, Emory University, Atlanta, GA, (5)Medicine, Emory University School of Medicine, Atlanta, GA

    Disclosures:

    J. Pack, Clinical Laboratory Services: Employee , Salary .

    Z. Zheng, None

    S. Sefton, None

    R. Moore, None

    S. Price, Clinical Laboratory Services: Employee , Salary .

    M. Camp Jr., Clinical Laboratory Services: Employee , Salary .

    S. Fridkin, Pfizer Inc.: Grant Investigator , Research support .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.