PURPOSE: Multi-drug resistant (MDR) pathogens and limited antimicrobials in development pose a major challenge for the management of infections. Collecting aggregate susceptibility data through the ARM program allows institutions to documents trends in antimicrobial susceptibilities and compare these data with local, regional, and national rates.We performed a pilot study that hypothesized data from the ARM program would identify unique institutional trends in antibiotic resistance that would differ from national rates.
METHODS: Antibiogram/sensitivity reports from a single medical center were incorporated into the database between 2001 and 2005. Data were reviewed for resistance trends for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis, Streptococcus pneumoniae, Stapylococcal aureus, methicillin-resistant Staphyloccal aureus (MRSA), Enterococcus faecium, and Enterococcus sp.
RESULTS: For E.coli, increasing resistance was found for ampicillin, levofloxacin, ciprofloxacin, and piperacillin. All were consistent with national averages, except ampicillin which was slightly higher. For K. pneumoniae, ciprofloxacin and levofloxacin resistance trended higher, along with most cephalosporins; however, all rates were below national averages. For P. aeruginosa, an increasing trend was identified for ceftazidime and imipenem, but both rates were lower than national averages. For P. mirabilis, increased resistance was found for ampicillin, ciprofloxacin, and imipenem. Resistance rates for ciprofloxacin were higher than national averages. For S. aureus, increased resistance was seen with erythromycin, ciprofloxacin, levofloxacin, and oxacillin. Methicillin-resistant S. aureus (MRSA) rates were higher than national averages. No trends were identified for Enterococcus sp. and S. pneumoniae. Penicillin-resistant S. pneumoniae rates are higher than national averages.
CONCLUSION: Aggregate ARM data identified resistance trends for E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis, S. aureus, and MRSA that were often different from national rates.
CLINICAL IMPLICATIONS: Identifying institutional trends allows benchmarking for appropriate interventions and validates antibiotic stewardship. In addition, stable resistance rates allow institutions to justify current formularies and treatment pathways with the ability to revise based on future results.
DISCLOSURE: Shawn Anderson, No Product/Research Disclosure Information; Grant monies (from industry related sources) The ARM Program receives un-restricted educational grants from Astra-Zeneca and Roche Pharmaceuticals