Comparison of an Emergency Department-Specific Antibiogram to Hospital Antibiogram: Influence of Patient Risk Factors on Susceptibility. (4th October 2017)

• Record Type: Journal Article
• Authors: Miller, Jessica; George, Amina; Wieczorkiewicz, Sarah M
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S257
• Page End: S258
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.561
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Traditional antibiograms use local resistance patterns and susceptibility data to guide empiric antimicrobial therapy selection. However, antibiograms are rarely unit-specific and do not account for patient-specific risk factors. The objective was to develop an Emergency Department (ED)-specific antibiogram and evaluate the impact of risk factors on antimicrobial susceptibility. Methods: This retrospective, single-center descriptive study used culture and susceptibility data from January 1 to December 31, 2016 to create an ED-specific antibiogram for the most commonly isolated organisms. Susceptibilities were then compared with the hospital antibiogram. All ED isolates were further stratified by the following risk factors: age, disposition from ED, previous antimicrobial use and/or hospitalization within 30 days, and presenting location. Descriptive statistics, Pearson Chi-Square/Fisher's Exact Tests, and logistic regression were performed. A two-tailed p -value of <0.05 was considered statistically significant. Results: A total of 2158 isolates from the ED were included: Escherichia coli (EC) ( n = 1244), Klebsiella pneumoniae (KP) ( n = 232), Proteus mirabilis (PM) ( n = 131), Pseudomonas aeruginosa (PA) ( n = 103), Staphylococcus aureus (SA) ( n = 303), and Enterococcus faecalis (EF) ( n = 145). The majority of patients were <65 years old ( n = 1088) and presented from the community ( n = 1800) with no antimicrobial exposure ( n = 1628) nor hospitalization ( n = 1895) within 30 days. There were no statistically significant differences between the ED and hospital antibiogram ( n = 5739) for KP, PM, PA, SA, and EF. The hospital antibiogram overestimated EC resistance rates for cefazolin (20% vs. 15.6%, P = 0.049), ceftriaxone (9.6% vs. 6.4%, P < 0.033), and ciprofloxacin (23.7% vs. 15.4%, P < 0.006). There were significantly more risk factors present in patients discharged from the ED vs. those admitted ( P < 0.0001). Healthcare facility residence had the greatest impact on susceptibility, especially EC (81.8% vs. 34.9%, P < 0.0001) and PM (75.3% vs. 33%, P < 0.0001) ciprofloxacin susceptibility. Conclusion: Development of an ED-specific antibiogram can aid physicians in prescribing appropriate empiric therapy when risk factors are included. Disclosures: All authors: No reported disclosures.