VA-GLA Infectious Diseases
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
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).
Head on over to the Guidelines section for guidance on doxycycline prophylaxis for sexually transmitted diseases!
The GLA antibiogram for calendar year 2022 is here! Head on over to the “Susceptibilities” tab to check it out. Some highlights:
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: 57% and 49% ceftriaxone susceptibility among nosocomial urinary and non-urinary E. coli, respectively).
Amikacin remains most active agent vs. multi-drug resistant Gram-negative rod infections at GLA.
If specific coverage for Pseudomonas is warranted, susceptibilities slightly favor piperacillin-tazobactam over cefepime and meropenem, though meropenem and ertapenem have better coverage against non-Pseudomonas Gram-negative nosocomial isolates.
Fluoroquinolone susceptibility versus most nosocomial Gram-negative organisms remains relatively poor.
For Gram-negative rods in the outpatient setting:
Cefazolin susceptibility among common urinary Enterobacterales is not readily captured but susceptibility rates among other beta-lactams remain relatively stable
Fluoroquinolone and TMP-SMX susceptibilities remain largely stable
Key trends among Gram-positive isolates:
MRSA 53% of nosocomial non-blood isolates, 76% of nosocomial blood isolates
MRSA ~40% outpatient non-blood isolates
Doxycycline susceptibility remains stable among non-blood outpatient S. aureus isolates (88%)
GLA COVID treatment protocols have been updated to reflect that EVUSHELD is no longer authorized for COVID prophylaxis in immunocompromised hosts. Head on over to the Guidelines section for the updated version.