Los Angeles County Regional Antibiogram:
A New Tool for Antibiotic Stewardship

Wendy Manuel Knight, MPH

Dawn Terashita, MD, MPH

March-April 2018

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Antimicrobial resistance (AR) is a global concern that presents a growing public health challenge. In order to help promote antimicrobial stewardship and reduce AR, the Los Angeles County Department of Public Health (DPH) has created the first LA County regional antibiogram.

 

The Regional Antibiogram

Antibiograms, defined as a summary of antimicrobial susceptibility rates for selected bacterial pathogens, provide comprehensive information about local antimicrobial resistance. They are usually generated by a laboratory using aggregate data from a hospital or healthcare system. This first LA County regional antibiogram aggregates voluntary data from 86 facility-level antibiograms to describe countywide patterns of resistance. DPH is using this community antibiogram to monitor and investigate antibiotic resistance across the county.

 

 

LA Antibiogram
 
 

The DPH antibiogram webpage includes tables for gram-negative and gram-positive organisms as well as information on background and methodology. The tables show, for each organism, the percent of isolates that were susceptible to each antibiotic.

Click on image to view a full size sample table.

 

 

Highlights from the LA County Regional Antibiogram

This community antibiogram aggregates facility-level data from 2015. There were several interesting findings including: Carbapenem-resistance (CR) among Escherichia coli isolates was lower than expected while CR among Pseudomonas aeruginosa isolates was higher than expected. Clindamycin susceptibility among group B streptococcus was surprisingly low. Further work is being done to better understand these findings.

 

Potential Uses of the Antibiogram

Below are three possible uses for the regional antibiogram in health care settings:

  • Guiding antimicrobial selection in serious infections. Within health care facilities, information from antibiograms are combined with clinical expertise to guide optimal antimicrobial treatment for patients with carbapenem-resistant enterobacteriaceae (CRE) or other serious infections.

  • Informing empiric therapy selection. Antibiograms can assist health care providers (HCPs) in selecting the best empiric antimicrobial therapy when culture and susceptibility results are not available. Therapy should be adjusted, if indicated, based on microbiology and susceptibility test results. One limitation for this use is that antibiograms do not have standard resistance thresholds.

    The regional antibiogram may be particularly useful for HCPs in smaller facilities or skilled nursing facilities that do not have a facility antibiogram, as well as for out-of-county facilities who are treating LA County residents.

  • Informing prescribing guidelines. Facilities are also encouraged to review the regional antibiogram at their antibiotic stewardship meetings to inform prescribing guidelines and/or formulary decisions.

DPH invites providers to complete a brief survey to give feedback on how the antibiogram will be used and how to improve it.

 

Future LA County Regional Antibiograms

The current antibiogram was based on voluntary submissions from acute care hospitals in LA County. As annual reporting of facility antibiograms is now mandated by a 2017 Health Officer order, future regional antibiograms will include data from over 400 LA County hospitals and skilled nursing facilities. Over time, with a series of regional antibiograms, DPH aims to assess trends in susceptibility and plan targeted prevention strategies and education campaigns.

 

Additional Resources

Antibiotic stewardship training for clinicians

The Centers for Disease Control and Prevention (CDC) Office of Antibiotic Stewardship announced a free webinar training with CME on antibiotic stewardship for physicians and other health care professionals. The first of four sessions is now available and the remaining sections will be released later this year. The course includes optimizing antibiotic prescribing and encouraging open discussion among physicians and patients. Visit CDC’s antibiotic stewardship website for more information.

Antibiotic Prescribing and Use in Doctor’s Office – CDC Website

Resources for HCPs working in outpatient and inpatient healthcare settings, as well as community pharmacies and nursing homes, are available at https://www.cdc.gov/antibiotic-use/community/for-hcp/index.html.

 

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Contact Information:

Wendy Manuel Knight, MPH
Epidemiologist

Dawn Terashita, MD, MPH
Medical Epidemiologist

Department of Public Health Acute Communicable Disease Control
County of Los Angeles

 

hai@ph.lacounty.gov

www.publichealth.lacounty.gov/acd


Rx for Prevention,
2018 March-April;8(2).