wisconsin state laboratory of hygiene 1 analysis and comparison of cumulative statewide antibiograms...
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WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 1
Analysis and Comparison Analysis and Comparison of Cumulative Statewide of Cumulative Statewide Antibiograms for Antibiograms for Wisconsin, 2006 and 2008Wisconsin, 2006 and 2008
Christina M. Carlson1, Tam T. Van2, Steve A. Marshall2, David M. Warshauer2, and Peter A. Shult2
1MPH Program, University of Wisconsin - Madison2Wisconsin State Laboratory of Hygiene, Communicable Diseases Division
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 2
Antimicrobial Resistance: An Antimicrobial Resistance: An ever-increasing public health ever-increasing public health problemproblem• 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.
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 3
Antimimicrobial Resistance: Antimimicrobial Resistance: TrendsTrends
0
10
20
30
40
50
60
70
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Per
cen
t R
esis
tan
ce
Methicillin (oxacillin)-resistant Staphylococcus aureus (MRSA) Among ICU Patients, 1995-2004
0
5
10
15
20
25
30
35
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Per
cen
t R
esis
tan
ce
Vancomycin-resistant EnterocociAmong ICU Patients,
1995-2004
0
5
10
15
20
25
30
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Per
cen
t R
esis
tan
ce
3rd generation cephalosporin-resistant Klebsiella pneumoniae Among ICU
Patients,1995-2004
05
101520
2530
3540
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
Per
cen
t R
esis
tan
ce
Fluoroquinolone-resistant Pseudomonas aeruginosa Among ICU
Patients,1995-2004
Source: CDC: National Nosocomial Infections Surveillance System. 2009.
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 4
Antibiogram:Antibiogram:
An overall profile of the antibiotic susceptibility of an organism to a collection of antimicrobial agents routinely tested and used
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
• 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
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 5
A Cumulative Statewide A Cumulative Statewide Antibiogram for WisconsinAntibiogram for Wisconsin
• Compare WI’s antimicrobial susceptibility status in 2006 and 2008
• Assess current challenges and needs regarding antimicrobial susceptibility testing (AST) in WI
Study Goals:
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 6
MethodsMethods
• 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
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 7
Local & regional anti-biograms received Local & regional anti-biograms received from WI healthcare facilities performing ASTfrom 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 2008
Provided an antibiogram in 2006
Provided an antibiogram in both 2006 & 2008
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 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
0
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verifiedreports
collectionperiod
(MM/YY)
reportpercent
susceptibile
speciesorganized
bymorphology
duplicatehandled
less than 10isolates
Pe
rce
nt
(%)
Nationwide
Wisconsin 2006
Wisconsin 2008
Nationwide data is from: Zapantis et. al. 2005 JCM, 43:2629. It includes antibiograms from 2000 – 2002.
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 9
WI cumulative statewide antibiogram for 2008Indicates a ≥10% decrease in susceptibility as compared
to 2006Indicates a ≥10% increase in susceptibility as compared to 2006
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 10
WI cumulative statewide antibiogram for 2008Indicates a ≥10% decrease in susceptibility as compared
to 2006Indicates a ≥10% increase in susceptibility as compared to 2006
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 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…
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 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
WISCONSIN STATE LABORATORY OF HYGIENEWISCONSIN STATE LABORATORY OF HYGIENE 13
Acknowledgements
Capstone CommitteeCapstone Committee Steve Marshall, MS David Warshauer, PhD Christopher Olsen, DVM, PhD
WI State Laboratory of HygieneWI State Laboratory of Hygiene Charles Brokopp, DrPH Peter Shult, PhD Tam Van, PhD (CDC EID Fellow)
UW MPH ProgramUW MPH Program Patrick Remington Barbara Duerst Heather Cote