Downstate Illinois Partnership Against Antibiotic Resistance

Wayne Mathews, MS, PA-CJustin Parker, MD

SIU Department of Family and Community Medicine

The presenters have no disclosures to make.

Focus: Regional Outpatient Antimicrobial Stewardship Initiative

• Web- based, online November 2014: www.siumed.edu/antibioticresistance

• Medical Education impacts training future primary care physicians: based in five downstate Family Medicine residencies.

• Purpose: analyze regional outpatient resistance patterns, educate providers on improving prescribing and patients on understanding scope of problem.

Scope and PartnersState and National-- Illinois Department of Public Health

Carbondale, IL-- Memorial Hospital of Carbondale-- SIU Family and Community Residency

Decatur, IL-- Decatur Memorial Hospital-- SIU Family and Community Residency-- St. Mary's Hospital

Quincy, IL-- Blessing Hospital-- SIU Family and Community Residency

Springfield, IL-- Memorial Medical Center-- SIU Family and Community Residency-- St. Mary's Hospital

Urbana, IL-- Carle Family Medicine Residency-- Carle Foundation Hospital-- Presence Hospital

THE PROBLEM: HOSPITAL VS. AMBULATORY ENVIRONMENT

Hospital: High Tech Tools, Surveillance, Infection Control Measures

THE PROBLEM: HOSPITAL VS. AMBULATORY ENVIRONMENT

Ambulatory: Lax monitoring, prescribing often by patient choice.

CURRENT STATE OF AMBULATORY ANTIBIOTIC PRESCRIBING

•Estimated 50% current antibiotic prescriptions unnecessary- CDC MMWR 2011

•833 antibiotic Rx per 1000 persons in US in 2010- NEJM, April 2013•Azithromycin most frequently prescribed antibiotic- highest in age < 10 and >65•High Regional variation

Regional Resistances

• Analyzed local hospital antibiograms for past 4 years for presence and trend of resistances.

• Criteria for analysis:

1. Bacteria which would likely be treated in the out-patient setting, where most antibiotic prescriptions occur. Example is Strep Pneumonia to Macrolides (Zithromax is the most frequently prescribed antibiotic in the US).

2. Bacteria which could be influenced by prescribing in the outpatient setting and test as resistant in the hospital. Example is Strep. Pneumonia to Ceftriaxone (Ceftriaxone is one of the first line antibiotics used to treat community acquired pneumonia), or Methicillin-resistant Staph Aureus.

3. Bacteria that evidence a trend of increasing resistance. Example is E. coli to Sulfas.

4. Bacteria with resistances mentioned by guidelines from the Infectious Disease Society of America, which should be used to guide empiric treatment. Example is caution using Sulfa in UTI: ‘avoid if resistance prevalence is known to exceed 20 %, or if used for UTI in previous 3 months’.

Regional Resistances of Concern 2014 West Central: # Isolates Bacteria Antibiotic Susceptibility Resistance Trend

118 Strep. Pneumonia Ceftriaxone 89% Less Susceptible118 Strep. Pneumonia Macrolides 43% Less Susceptible819 E. Coli TMP/SMX 76% Less Susceptible357 Staph Aureus MRSA Clindamycin 49% Less Susceptible149 Proteus M. Quinolones 56% Less Susceptible

Bacteria # Isolates Antibiotic Susceptibility Resistance TrendStrep Pneumonia 88 Macrolides 56% Less Susceptible

E. Coli 1341 Quinolones 78% Less Susceptible

E. Coli 1340 TMP/SMX 78% Less Susceptible

Staph aureus 1115 MRSA rate 54% Less Susceptible

Proteus M. 99 Quinolones 54% Stable

East Central:

Regional Resistances of ConcernWest:

Bacteria # Isolates Antibiotic Susceptibility Resistance TrendE. coli 1363 Quinolones 79% Less Susceptible

E. coli 1363 TMP/SMX 76% Less Susceptible

Enterococcus 302 Vancomycin 90% Less Susceptible

Staph Aureus 539 Inducible Clindamycin resistance 89%

Unknown

Staph Aureus 144 MRSA Rate 52% Less SusceptibleProteus M. 188 Quinolones 59% Stable

Bacteria # Isolates Antibiotic Susceptibility Resistance TrendE. Coli 552 TMP/SMX 76% StableE. Coli 552 Quinolones 72% Less Susceptible

Strep Pneumonia 26 Macrolides 36%

Less Susceptible

Staph aureus 1040 MRSA Rate 57% Less Susceptible

Bacteria # Isolates Antibiotic Susceptibility Resistance TrendE. Coli 552 TMP/SMX 76% Less SusceptibleE. Coli 552 Quinolones 72% Less SusceptibleMRSA 162 Clindamycin 70% Less SusceptibleStrep Pneumonia 26 Macrolides 36% Less Susceptible

East:

South:

Projects Underway

• Partner with IDPH on Precious Drugs and Scary bugs Campaign using method of Meeker at al: nudging guideline concordant antibiotic prescribing. JAMA Internal Medicine 2014.

• Survey on Antibiotic Stewardship to US Family Medicine Program Directors.

• Educate ED providers on AS issues.• Study Effects of LTC prescribing for Asymptomatic

Bacteruria on UTI resistance patterns.• News Releases, participated in Get Smart with

Antibiotics Week.

Family Medicine Program Directors Survey

• Survey to 288 FM PD’s• 98% identified Antibiotic Stewardship as

Important to Extremely Important.• 67% stated program involvement of Infectious

disease faculty physician.• 73% stated program had no plans to change

curriculum for AS in next year.• Only 14% had an AS quality improvement

metric in place.