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Analysis and Comparison of Cumulative Statewide Antibiograms for Wisconsin, 2006 and 2008

Analysis and Comparison of Cumulative Statewide Antibiograms for Wisconsin, 2006 and 2008. Christina M. Carlson 1 , Tam T. Van 2 , Steve A. Marshall 2 , David M. Warshauer 2 , and Peter A. Shult 2 1 MPH Program, University of Wisconsin - Madison

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Analysis and Comparison of Cumulative Statewide Antibiograms for Wisconsin, 2006 and 2008

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  1. Analysis and Comparison of Cumulative Statewide Antibiograms for Wisconsin, 2006 and 2008 Christina M. Carlson1, Tam T. Van2, Steve A. Marshall2, David M. Warshauer2, and Peter A. Shult2 1MPH Program, University of Wisconsin - Madison 2Wisconsin State Laboratory of Hygiene, Communicable Diseases Division

  2. Antimicrobial Resistance: An ever-increasing public health problem • U.S. Healthcare-associated infections: -1.7 million infections (1 in 10 patients) -99,000 associated deaths/yr -6.7 billion annual economic burden (2002) • Staphylococcus aureus ->95% of penicillin resistant -60% methicillin resistant • >20% of all Enterococcus infections resistant to Vancomycin Source: CDC. 2009. Antimicrobial resistance in healthcare settings fact sheet.

  3. Vancomycin-resistant Enterococi Among ICU Patients, 1995-2004 Methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) Among ICU Patients, 1995-2004 Antimimicrobial Resistance: Trends Fluoroquinolone-resistant Pseudomonas aeruginosa Among ICU Patients,1995-2004 3rd generation cephalosporin-resistant Klebsiella pneumoniae Among ICU Patients,1995-2004 Source: CDC: National Nosocomial Infections Surveillance System. 2009.

  4. Antibiogram: An overall profile of the antibiotic susceptibility of an organism to a collection of antimicrobial agents routinely tested and used • Monitor resistance trends • Reveal emergence of potential novel resistance • Aid clinicians in empiric treatment of infections • Problem: Lack of standardized data • Clinical Laboratory Standards Institute guidelines for preparation of antibiograms

  5. A Cumulative Statewide Antibiogram for Wisconsin Study Goals: • Compare WI’s antimicrobial susceptibility status in 2006 and 2008 • Assess current challenges and needs regarding antimicrobial susceptibility testing (AST) in WI

  6. Methods • Preparation of cumulative antibiogram -requested 2008 antibiograms from 135 clinical/ reference laboratories in WI -calculated average % susceptibility for selected antimicrobial agent-organism combinations -2008 cumulative susceptibility patterns compared with 2006 • Evaluation of antibiograms -CLSI M39-A2 and M100-S19 documents -WI adherence to CLSI guidelines compared with adherence nationally

  7. Local & regional anti-biograms received from WI healthcare facilities performing AST • 47 of the 87 (54%) healthcare facilities performing AST contributed antibiograms in 2006 and 2008 • 28 common sites provided antibiograms in 2006 and 2008 Provided an antibiogram in 2006 Provided an antibiogram in 2008 Provided an antibiogram in both 2006 & 2008

  8. Comparison of local/regional antibiograms in WI and nationwide meeting CLSI recommendations • WI antibiograms showed at least 70% compliance to 4 of the 6 CLSI elements analyzed • Adherence to CLSI guidelines in 2008 WI antibiograms, as compared to 2006, improved in all elements analyzed, except 1) reporting verified susceptibility results and 2) indicating the use of duplicates Nationwide data is from: Zapantis et. al. 2005 JCM, 43:2629. It includes antibiograms from 2000 – 2002.

  9. Indicates a ≥10% decrease in susceptibility as compared to 2006 WI cumulative statewide antibiogram for 2008 Indicates a ≥10% increase in susceptibility as compared to 2006

  10. Indicates a ≥10% decrease in susceptibility as compared to 2006 WI cumulative statewide antibiogram for 2008 Indicates a ≥10% increase in susceptibility as compared to 2006

  11. Conclusions • WI healthcare facilities can improve on current antibiograms by: 1) excluding duplicates from their data and indicating so 2) excluding susceptibility data for organisms with <10 isolates • WI susceptibility data for 2008 is largely comparable to that of 2006, and overall susceptibility patterns in WI show less resistance compared to the nation • Susceptibility patterns among multiple organism-agent combinations between 2006 & 2008 statewide antibiograms suggest the need for increased adherence to CLSI practice guidelines in WI • Statewide antibiograms should only be used for surveillance purposes and not to guide empiric therapy for individual patients YET…

  12. Future Directions • Develop a standardized & sustainable strategy to the development of an annual statewide antibiogram for WI -survey a subset of high capacity laboratories in each public health region -a more precise and accurate statewide antibiogram useful to facilities that cannot/do not compile their own • Continued development of WSLH-sponsored surveys, workshops, teleconferences, webinars aimed at monitoring & improving AST practices in WI healthcare facilities

  13. Acknowledgements Capstone Committee  Steve Marshall, MS  David Warshauer, PhD  Christopher Olsen, DVM, PhD UW MPH Program  Patrick Remington  Barbara Duerst  Heather Cote WI State Laboratory of Hygiene  Charles Brokopp, DrPH  Peter Shult, PhD  Tam Van, PhD (CDC EID Fellow)

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