New antibiogram!

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The new GLA antibiogram compiling antimicrobial susceptibility data for calendar year 2025 is here! Head on over to the “Susceptibilities” tab to check it out!

Relevant issues:

For Gram-negative rods in the hospital setting (cultures obtained > 48 hours after hospitalization):

Nosocomial non-urine and urine culture susceptibilities remain largely stable (some improvements in P. aeruginosa and some decreases in E. coli and K. pneumoniae susceptibilities). Ceftriaxone susceptibilities were not readily captured for E. cloacae for most non-urine isolates, however, ertapenem has better coverage against non-Pseudomonas Gram-negative nosocomial isolates. Nosocomial ESBL E. coli rates remain relatively stable (<40%).

 

Carbapenem-resistant Enterobacterales remain uncommon at GLA.

 

If specific coverage for Pseudomonas is warranted, susceptibilities are variable across piperacillin-tazobactam, cefepime and meropenem, though cefepime susceptibilities have improved compared to prior antibiograms to the point to where it should be preferred over piperacillin-tazobactam and meropenem when nosocomial Pseudomonas is specifically suspected.  Please consult Infectious Diseases if you have a concern for a highly resistant organism.  Reminder, for blood isolates, the BioFire BCID platform tests for common antimicrobial resistance genes, and a guide to its interpretation can be found at vaglaid.org/rapiddx.

 

For Gram-negative rods in the outpatient setting (cultures obtained in outpatients, ED, or within 48 hours of admission):

Cephalexin (inferred from cefazolin) remains a preferred front-line option for empiric treatment of outpatient UTI than fluoroquinolones based 79-85% versus 64-86% susceptibility among outpatient E. coli, K. pneumoniae, and P. mirabilis isolates. Nitrofurantoin remains great empiric option for cystitis with 96% susceptibility for E. coli urinary isolates.  For community-acquired urosepsis/pyelonephritis, ceftriaxone is a more reliable option. Susceptibility rates among other beta-lactams remain relatively stable, as do fluoroquinolone and TMP-SMX susceptibilities. Outpatient ESBL E. coli rates remain relatively stable (<20).

 

Key trends among Gram-positive isolates:

54% of nosocomial non-urine S. aureus isolates are MRSA, but only 39% of outpatient non-urine S. aureus isolates are MRSA.  Of blood isolates, 50% are MRSA.

 

Tetracycline resistance in non-urine S. aureus is more common than trimethoprim-sulfamethoxazole resistance.  However, at least 50% of non-urine tetracycline-resistant S. aureus isolates retain doxycycline susceptibility. 

 

VRE is relatively uncommon (7 nosocomial non-urine isolates and 11 outpatient non-urine isolates).

Happy Antibiotic Awareness Week!

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November 17-21, 2025, is VHA Antibiotic Awareness Week!

This year’s Theme is --  Act Now! Join the Fight Against Antimicrobial Resistance!

 

This year’s daily topics include:

Mon: Act Now! Fight to Prevent Infections with Resistant Organisms and C. difficile!

Tues: Act Now! Use Recommended Antibiotic Duration to Fight Resistance!

Wed: Act Now! Use Recommended Antibiotics to Fight Resistance!

Thur: Act Now! Use Diagnostic Stewardship to Fight Resistance!

Fri: Act Now! Use Accurate Allergy Histories to Fight Resistance!

Click HERE for materials!

New antibiogram!

/

The new GLA antibiogram compiling antimicrobial susceptibility data for calendar year 2024 is here! Head on over to the “Susceptibilities” tab to check it out!

We have moved to a different platform to capture microbiologic data, so things might look slightly different from how they have looked in the past.  Most notably, the overall number of urine cultures included has decreased, which we think represents better capture of each individual patient’s contribution (i.e., less duplicate isolates).

Key takeaways:

For Gram-negative rods in the hospital setting:

Improvement in susceptibilities compared to prior antibiograms are particularly notable among common nosocomial non-urine culture isolates, especially ceftriaxone susceptibility in E. cloacae, E. coli, and K. pneumoniae.  Nosocomial urine culture susceptibilities remain largely stable (some improvements in K. pneumoniae and some decreases in P. aeruginosa susceptibilities).

Carbapenem-resistant Enterobacterales remain uncommon at GLA.

If specific coverage for Pseudomonas is warranted, susceptibilities are variable across piperacillin-tazobactam, cefepime and meropenem, though meropenem and ertapenem have better coverage against non-Pseudomonas Gram-negative nosocomial isolates.  Please consult Infectious Diseases if you have a concern for a highly resistant organism.  Reminder, for blood isolates, the BioFire BCID platform tests for common antimicrobial resistance genes, and a guide to its interpretation can be found at vaglaid.org/rapiddx.

 For Gram-negative rods in the outpatient setting:

Cefazolin susceptibility among common urinary Enterobacterales is now readily captured.  Cefazolin susceptibility can be used to infer cephalexin susceptibility.  Cephalexin remains a front-line option for empiric treatment of outpatient UTI based on 85% and 91% susceptibility among outpatient E. coli and K. pneumoniae, respectively, but is less reliable for empiric UTI treatment in the inpatient setting.  For community-acquired urosepsis/pyelonephritis, however, ceftriaxone is a more reliable option.  Susceptibility rates among other beta-lactams remain relatively stable, as do fluoroquinolone and TMP-SMX susceptibilities.

Key trends among Gram-positive isolates:

 62% of nosocomial non-urine S. aureus isolates are MRSA, but only 35% of outpatient non-urine S. aureus isolates are MRSA.  Of blood isolates, 45% are MRSA.

Tetracycline resistance in non-urine S. aureus is more common than trimethoprim-sulfamethoxazole resistance.  However, at least 50% of non-urine tetracycline-resistant S. aureus isolates retain doxycycline susceptibility. 

VRE is relatively uncommon (10 nosocomial isolates and 11 outpatient isolates).