Transcript Regional Resistances of Concern 2014

Downstate Illinois Partnership Against
Antibiotic Resistance
Wayne Mathews, MS, PA-C
Justin Parker, MD
SIU Department of Family and Community
Medicine
The presenters have no disclosures to make.
Focus: Regional Outpatient Antimicrobial
Stewardship Initiative
• Web- based, online November 2014:
www.siumed.edu/antibioticresistance
• Medical Education impacts training future
primary care physicians: based in five
downstate Family Medicine residencies.
• Purpose: analyze regional outpatient
resistance patterns, educate providers on
improving prescribing and patients on
understanding scope of problem.
Scope and Partners
State and National
-- Illinois Department of Public Health
Carbondale, IL
-- Memorial Hospital of Carbondale
-- SIU Family and Community Residency
Decatur, IL
-- Decatur Memorial Hospital
-- SIU Family and Community Residency
-- St. Mary's Hospital
Quincy, IL
-- Blessing Hospital
-- SIU Family and Community Residency
Springfield, IL
-- Memorial Medical Center
-- SIU Family and Community Residency
-- St. Mary's Hospital
Urbana, IL
-- Carle Family Medicine Residency
-- Carle Foundation Hospital
-- Presence Hospital
THE PROBLEM: HOSPITAL VS.
AMBULATORY ENVIRONMENT
Hospital: High Tech Tools, Surveillance,
Infection Control Measures
THE PROBLEM: HOSPITAL VS.
AMBULATORY ENVIRONMENT
Ambulatory: Lax monitoring, prescribing
often by patient choice.
CURRENT STATE OF AMBULATORY
ANTIBIOTIC PRESCRIBING
•Estimated 50% current antibiotic prescriptions unnecessaryCDC MMWR 2011
•833 antibiotic Rx per 1000 persons in US in 2010- NEJM,
April 2013
•Azithromycin most frequently prescribed antibiotic- highest
in age < 10 and >65
•High Regional variation
Regional Resistances
• Analyzed local hospital antibiograms for past 4 years
for presence and trend of resistances.
• Criteria for analysis:
1. Bacteria which would likely be treated in the out-patient setting, where most
antibiotic prescriptions occur. Example is Strep Pneumonia to Macrolides
(Zithromax is the most frequently prescribed antibiotic in the US).
2. Bacteria which could be influenced by prescribing in the outpatient setting and
test as resistant in the hospital. Example is Strep. Pneumonia to Ceftriaxone
(Ceftriaxone is one of the first line antibiotics used to treat community acquired
pneumonia), or Methicillin-resistant Staph Aureus.
3. Bacteria that evidence a trend of increasing resistance. Example is E. coli to
Sulfas.
4. Bacteria with resistances mentioned by guidelines from the Infectious Disease
Society of America, which should be used to guide empiric treatment. Example is
caution using Sulfa in UTI: ‘avoid if resistance prevalence is known to exceed 20 %,
or if used for UTI in previous 3 months’.
Regional Resistances of Concern 2014
West Central:
# Isolates
118
118
819
357
149
Bacteria
Strep. Pneumonia
Strep. Pneumonia
E. Coli
Staph Aureus MRSA
Proteus M.
Antibiotic Susceptibility
Ceftriaxone
89%
Macrolides
43%
TMP/SMX
76%
Clindamycin
49%
Quinolones
56%
Resistance Trend
Less Susceptible
Less Susceptible
Less Susceptible
Less Susceptible
Less Susceptible
East Central:
Bacteria
Strep Pneumonia
E. Coli
E. Coli
Staph aureus
Proteus M.
# Isolates
88
1341
1340
1115
99
Antibiotic Susceptibility
Macrolides
56%
Quinolones
78%
TMP/SMX
78%
MRSA rate
54%
Quinolones
54%
Resistance Trend
Less Susceptible
Less Susceptible
Less Susceptible
Less Susceptible
Stable
Regional Resistances of Concern
West:
East:
South:
Bacteria
E. coli
E. coli
Enterococcus
Staph Aureus
# Isolates
1363
1363
302
539
Staph Aureus
Proteus M.
Bacteria
E. Coli
E. Coli
Strep Pneumonia
Staph aureus
Bacteria
E. Coli
E. Coli
MRSA
Strep Pneumonia
Resistance Trend
144
188
Antibiotic Susceptibility
Quinolones
79%
TMP/SMX
76%
Vancomycin
90%
Inducible Clindamycin
resistance
89%
MRSA Rate
52%
Quinolones
59%
# Isolates
552
552
26
1040
Antibiotic Susceptibility
TMP/SMX
76%
Quinolones
72%
Macrolides
36%
MRSA Rate
57%
Resistance Trend
Stable
# Isolates
552
552
162
26
Antibiotic Susceptibility
TMP/SMX
76%
Quinolones
72%
Clindamycin
70%
Macrolides
36%
Less Susceptible
Less Susceptible
Less Susceptible
Unknown
Less Susceptible
Stable
Less Susceptible
Less Susceptible
Less Susceptible
Resistance Trend
Less Susceptible
Less Susceptible
Less Susceptible
Less Susceptible
Projects Underway
• Partner with IDPH on Precious Drugs and Scary
bugs Campaign using method of Meeker at al:
nudging guideline concordant antibiotic
prescribing. JAMA Internal Medicine 2014.
• Survey on Antibiotic Stewardship to US Family
Medicine Program Directors.
• Educate ED providers on AS issues.
• Study Effects of LTC prescribing for Asymptomatic
Bacteruria on UTI resistance patterns.
• News Releases, participated in Get Smart with
Antibiotics Week.
Family Medicine Program Directors Survey
• Survey to 288 FM PD’s
• 98% identified Antibiotic Stewardship as
Important to Extremely Important.
• 67% stated program involvement of Infectious
disease faculty physician.
• 73% stated program had no plans to change
curriculum for AS in next year.
• Only 14% had an AS quality improvement
metric in place.