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).

 

New antibiogram!

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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%)