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Antimicrobial resistance patterns and empiric antibiotic selections for patients admitted from post-acute care
Sandhya Vijapurapu1, Christina Maguire1, Amanda Binkley1
1Penn Presbyterian Medical Center, Philadelphia, PA, USA.
Insights
Patients from post-acute care facilities (PACFs) show different bacterial resistance patterns. This highlights the need to adjust empiric antibiotic strategies for this population to improve treatment outcomes.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Healthcare Epidemiology
Background:
- Patients admitted from post-acute care facilities (PACFs) represent a unique population with potentially distinct microbial profiles.
- Understanding antimicrobial susceptibility patterns in this group is crucial for effective treatment and infection control.
Purpose of the Study:
- To characterize bacterial susceptibilities in patients admitted from PACFs.
- To evaluate the appropriateness of empiric antimicrobial regimens for this patient cohort.
Main Methods:
- Retrospective quality improvement study conducted at two tertiary care teaching hospitals.
- Inclusion of patients with positive bacterial cultures within 72 hours of admission from PACFs.
- Comparison of susceptibility data between PACF patients and the general hospital antibiogram.
Main Results:
- A significant proportion of patients (36.5%) received inappropriate empiric therapy based on culture results.
- Elevated resistance rates for *Escherichia coli* and *Klebsiella pneumoniae* to key antibiotics (levofloxacin, ceftriaxone, cefepime) were observed in PACF patients.
- Higher rates of extended-spectrum β-lactamase (ESBL) resistance were identified in the PACF cohort.
Conclusions:
- Clinically significant differences in antimicrobial susceptibility exist between PACF patients and the general hospital population.
- Increased antimicrobial resistance in PACF patients necessitates a review of current empiric antibiotic prescribing practices.
- Tailoring antibiotic strategies for PACF admissions may improve patient outcomes and combat resistance.
Purpose:
To characterize the susceptibilities of positive bacterial cultures and the appropriateness of empiric antimicrobial regimens for patients admitted from post-acute care facilities (PACFs).
Methods:
This was a retrospective quality improvement study. The study included patients admitted from a PACF to one of 2 tertiary care teaching hospitals within the University of Pennsylvania Health System, located in Philadelphia, PA, from August 2020 to December 2021. Patients were included if they had at least one positive culture within 72 hours of admission.
Results:
A total of 167 patients and 230 isolates from the study period were evaluated. The majority of positive cultures were from a urinary source (114 of 230, 49.6%). Nineteen patients (11.4%) had a history of multidrug-resistant organisms. The most common empiric antibiotics used were vancomycin (61.7%) and cefepime (59.3%). Sixty-one patients (36.5%) received inappropriate empiric therapy based on the culture results. When comparing our hospitals' general antibiogram to that of only PACF patients, Escherichia coli and Klebsiella pneumoniae had at least a 20% difference in susceptibility to levofloxacin, ceftriaxone, and cefepime. Extended-spectrum β-lactamase resistance was also higher in the PACF cohort (odds ratio, 2.09; 95% confidence interval, 1.4-3.1).
Conclusion:
Clinically significant differences in antimicrobial susceptibility were found among patients admitted from PACFs compared to our health system's general antibiogram. The increased resistance rates identified in this study support the need for hospitals to evaluate this at-risk patient population, which may drive changes to empiric antibiotic prescribing practices.
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