Antimicrobial Stewardship/Statewide Antibiogram Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services

Disclosures Employee of BD Corporation MedMined™ Services © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Agenda CMS and JCAHO CDC Outpatient AMS Antibiogram Antibiotics © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

JCAHO and CMS

Regulatory JCAHO MMS 09.01.01 Effective January 1, 2017 CMS Antimicrobial Stewardship requirement October 4, 2016 CMS published the final rule adding AMS to the 1986 infection control condition of participation (CoP) Hospitals must met CoP to receive payments

Regulatory CMS-3295-P Updates have been delayed because new administration has taken office 3/13 Seema Verma, MPH, confirmed as Medicare and Medicaid Administrator 3/24 House Republicans removed bill to repeal and replace the ACA from House floor vote Although it’s not a controversial rule, it will be reviewed because it will cost money – up to $1 billion Final ruling will be November 10th

Regulatory CMS-3295-P Infection Prevention Focus on prevention Ensuring the Infection Preventionist is actually trained in Infection Prevention Focus on transmission across the care continuum including patients, hospital personnel, visitors, environment and other outpatient facilities

Regulatory CMS-3295-P Antimicrobial Stewardship Require hospitals to have policies and procedures for, and to demonstrate evidence of, an active and hospital-wide antibiotic stewardship program.  Hospitals would be required to improve their internal coordination among all components responsible for antibiotic use

CDC Outpatient Antimicrobial Stewardship

Regulatory CDC Outpatient Antibiotic Stewardship Developed in response to Executive Order 13676: Combating Antibiotic-Resistant Bacteria—issued by President Barack Obama on September 18, 2014 The National Action Plan outlines steps for implementing the National Strategy for Combating Antibiotic-Resistant Bacteria 3/2014 9/2015 11/2016

Regulatory CDC Outpatient Antibiotic Stewardship 2009 $10.7 Billion Spent on Antibiotics in US 61.5% outpatient 33.6% inpatient 4.9% long-term care settings Suda KJ, A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009. JAC. 2013;68:715–8.

Regulatory CDC Outpatient Antibiotic Stewardship Intended Audiences Health care systems Urgent care clinics and clinicians Retail health clinics and clinicians Outpatient specialty and subspecialty clinics Primary care clinics Emergency departments (EDs) Dental clinics and dentists Nurse practitioners and physician assistants

Regulatory CDC Outpatient Antibiotic Stewardship Core elements Commitment Action for policy and practice Tracking and reporting Education and expertise

Regulatory CDC Outpatient Antibiotic Stewardship Commitment Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety by all healthcare team members

Regulatory CDC Outpatient Antibiotic Stewardship Action for policy and practice Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed. Diagnosis guidelines Prescribing guidelines Written justification in chart

Regulatory CDC Outpatient Antibiotic Stewardship Tracking and reporting Monitor antibiotic prescribing practices and offer regular feedback to clinicians, or have clinicians assess their own antibiotic prescribing practices themselves. Chart review Follow-up on initiatives

Regulatory CDC Outpatient Antibiotic Stewardship Education and expertise Provide educational resources to clinicians and patients on antibiotic prescribing, and ensure access to needed expertise on optimizing antibiotic prescribing Communication strategies Patient education

AHQI Antibiogram © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

What is included? Duplicate isolates removed Significantly different susceptibility results are considered unique or non-duplicate Includes data from 1/2016 to 12/2016 Isolates from 56 hospitals in Alabama One isolate per organism per 365 day period © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Community versus Hospital Community isolate That which is collected from an outpatient or an inpatient within the first 3 days of an admission who has had no admissions within the past 14 days Hospital isolate That which is collected from a inpatient on or after day 3 of an admission or within 14 days of discharge © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Hospital Enterococcus Isolates (Non-Urine) 31% (29%) of Enterococcus isolates are the more resistant faecium strain © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Vancomycin Resistant E Faecium (Hospital Non-Urine) © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Hospital MRSA (Non-Urine) Infection prevention is important © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

MRSA All HAIs | 2011-2014 http://www.cdc.gov/hai/surveillance/ar-patient-safety-atlas.html © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

MRSA Hospital versus Community (Non-Urine) Infection prevention is important © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Klebsiella pneumonia Isolates Resistant to Meropenem (KPC) Previous presentations have reported K. pneumonia strains tested against imipenem. A greater number of hospitals have been testing meropenem instead of imipenem. We will report meropenem moving forward. 2015 testing against imipenem showed 5549 isolates tested with 206 being resistant. © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Hospital Non-Urine A. baumannii Isolates Susceptible to Meropenem © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Carbapenms R or I Acinetobacter NATIONAL HAIs | 2011-2014 http://www.cdc.gov/hai/surveillance/ar-patient-safety-atlas.html © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

MDR Acinetobacter Isolate Alabama Hospitals © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Hospital P. aeruginosa Non-Urine B-Lactams Pipercillin/Tazobactam and Cefepime are stable Aztreonam has continued to steadily improve over the last 5 years © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Hospital P. aeruginosa Non-Urine Aminoglycosides Amikacin and Tobramycin steady at over 90% Gentamicin continues to improve over the last 4 years © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Hospital P. aeruginosa Non-Urine Carbapenems P. aeruginosa susceptibility to imipenem at it lowest since data collection started, 68% Meropenem declining since 2011 Concern here as this one of our last lines of defense against resistant gram negative bacteria. © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Hospital P. aeruginosa Non-Urine Quinolones Poor activity against Pseudomonas There is a trend towards improvement over the past 3 years and since 2006 © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiogram Summary Enterococcus faecium resistant to vancomycin or linezolid, hospital non-urine, remains stable (80%, 6%) MRSA, hospital non-urine, trend continues to decline. Geographically, still high. CRKP, hospital and community, declined in 2016. Monitor closely. A. baumannii , hospital non-urine, susceptibility improved (70% vs 64%). Still a dangerous pathogen. P. aeruginosa, hospital non-urine, resistance to carbapenems a concern with overall trend declining © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

AHQI Antibiotic Utilization © 2016 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiotic National Comparison Antibiotics © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiotic National Comparison Carbapenems © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiotic National Comparison Piperacillin / Tazobactam © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiotic National Comparison Vancomycin, Linezolid, Daptomycin, Tigecycline © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiotic National Comparison Quinolones © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiotic National Comparison 3rd/4th Generation Cephalosporins © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

Antibiotic National Comparison Proton Pump Inhibitors © 2017 BD.  BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

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