New antibiogram!

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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).

Yellow Fever Vaccination now available at GLA!

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GLA is now officially offering Yellow Fever (YF) vaccinations through the Infectious Diseases service at WLA ID Travel clinic on Friday mornings via ID outpatient consult starting 2/21/2025. Please note YF vaccine must be given at least 10 days prior to travel and requires completion of International Certificate of Vaccination and Prophylaxis (ICVP) by a designated YF provider (ID team).  Additionally, ID has a new ID Travel Prophylaxis and Vaccines menu for ordering routine vaccines, ID-restricted vaccines (via ID e-consult), malaria prophylaxis, and empiric traveler’s diarrhea treatment (ID Consult -> Consult for Outpatient Infectious Disease -> ID Travel Prophylaxis and Vaccines).

Happy Antibiotic Awareness Week!

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U.S. Antibiotic Awareness Week (USAAW) is observed each year from November 18-24. The purpose of the observance is to raise awareness of the importance of appropriate antibiotic and antifungal use and the threat antimicrobial resistance poses to people, animals, plants, and their shared environment.

U.S. Antibiotic Awareness Week (USAAW) | Antimicrobial Resistance | CDC

New antibiogram!

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The new 2023 GLA antibiogram is here (now featuring improved capture of urinary cefazolin susceptibilities)!

Key takeaways:

For Gram-negative rods in the hospital setting:

 

Carbapenem-resistant Enterobacterales remain relatively uncommon at GLA, but extended-spectrum beta-lactamase-producing Gram-negative rods are common in the nosocomial setting (example: 58% and 49% ceftriaxone susceptibility among nosocomial urinary and non-urinary E. coli, respectively).

 

 Fluoroquinolone susceptibilities seem to be improving somewhat across the board.

 

If specific coverage for Pseudomonas is warranted, there is not much difference between 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 more 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 80% and 89% susceptibility among outpatient E. coli and K. pneumoniae, respectively, but is less reliable for empiric UTI treatment in the inpatient setting.  Susceptibility rates among other beta-lactams remain relatively stable, as do fluoroquinolone and TMP-SMX susceptibilities.

 

 

Key trends among Gram-positive isolates:

 

 53% of nosocomial non-blood S. aureus isolates are MRSA, as are 44% of nosocomial blood S. aureus isolates.

 

 MRSA represents ~40% of outpatient non-blood S. aureus isolates.

 

 Doxycycline susceptibility remains stable among outpatient S. aureus isolates (84% non-blood, 94% blood) but is decreasing somewhat in the nosocomial setting (83% non-blood, 78% blood).