The Healthcare Associated Infections Program at CDPH manages the California Antibiogram Project which collects information on specific antimicrobial-organism combinations across California general acute care hospitals. Participation is optional and hospital identifiers are voluntary. We are continuing to build our list of hospital laboratorians. Please send us an e-mail with contact information for these key persons at your hospital, so that we can directly provide information on the California Antibiogram Project and any relevant educational webinars in the future. Please e-mail CDPHCaliforniaAntibiogramProject@cdph.ca.gov
To participate please go to: https://www.surveymonkey.com/s/CAAntibiogramProject2011
We will be conducting a statewide webinar in August 2012 to summarize the 2008-2010 California Antibiogram Project results and provide education on carbapenem-resistant Acinetobacter baumannii.
Please keep in mind that the due date for completing the survey is November 30, 2012.
Thank you for your participation.
The 2008-2010 Project provided clinical and public health laboratories with a summary of these results in two webinars held in January 2013. The webinar slides were prepared and presented by Kavita Trivedi, Medical Epidemiologist with the Healthcare Associated Infections Program at CDPH, Kelsey Oyong, MPH, CSTE HAI Fellow with the LA County Public Health Department and Janet Hindler, MCLS MT (ASCP), Senior Specialist with Clinical Microbiology at UCLA Medical Center.
Their presentations are here: Webinar CAAbProject.2011.pdf and Hindler.CumAntibiogram.2011.pdf. Over 275 people participated in the Webinars.
California Antibiogram Project 2007
The following bacteria were chosen for inclusion in the cumulative antibiogram reports based on a combination of factors, including recent emerging resistance patterns, availability of standardized laboratory test results and public health importance
| Acinetobacter baumannii complex
| Escherichia coli
| Klebsiella pneumoniae
| Pseudomonas aeruginosa
| Salmonella spp.
Acinetobacter baumannii complex
Acinetobacter baumannii members are gram-negative rods commonly found in soil and water. They have emerged in the past 30 years from having questionable pathogenicity to being a multidrug resistant cause of major morbidity and mortality in healthcare settings, particularly intensive care units. People who have weakened immune systems, chronic lung disease, or diabetes may be more susceptible to infections with Acinetobacter, including pneumonia, wound infections and bacteremia. Hospitalized patients, especially very ill patients on a ventilator, those with a prolonged hospital stay, or those who have open wounds, are also at greater risk for Acinetobacter infection. A. baumannii is generally intrinsically resistant to aminopenicillins and first- and second-generation cephalosporins, and has a remarkable capacity to acquire resistance to broad-spectrum β-lactams, aminoglycosides, fluoroquinolones and tetracycline, often rendering them resistant to virtually all available antibiotics. Panresistant strains resistant to first-line antimicrobials such as aminoglycosides, fluoroquinolones, and β-lactams including carbapenems are being increasingly reported worldwide.
Escherichia coli are gram-negative rods that are an important cause of community and hospital-acquired urinary tract infections, acute cystitis, and pyelonephritis. Certain E.colistrains can also cause gastroenteritis. Over the past decade, rates of resistance have been rising to include commonly used drugs such as trimethoprim-sulfamethoxazole and ampicillin, in both healthcare and community settings. More recently, resistance to fluoroquinolones has significantly increased. Of particular concern are those E.coli that are able to produce enzymes called extended- spectrum beta-lactamases (ESBL) that conveys resistance to multiple drugs commonly used in the hospital.
Klebsiella pneumoniae is a gram-negative bacteria that is a common hospital-acquired pathogen, causing infections of the urinary tract, abdomen, surgical wounds, invasive medical devices as well as nosocomial pneumonia. Community-acquired pneumonia due to K. pneumoniae is seen in people with underlying diseases, such as alcoholism, diabetes and chronic lung disease. Extensive use of broad-spectrum antibiotics in hospitalized patients has led to the development of multidrug-resistant strains that produce extended-spectrum beta-lactamase (ESBL) and can spread quickly. Recently, the spread of K. pneumoniae carbapenemase (KPC)-producing organisms, one of the most treatment-resistant gram-negative bacteria associated with high morbidity and mortality, has been reported in the eastern and central US. To date, only a few KPC-producing isolates have been reported in California.
Pseudomonas aeruginosa are gram-negative rods that are commonly found in soil, water, plants and animals (including humans). While infection in healthy persons is rare, P. aeruginosa is a frequent cause of nosocomial infections such as pneumonia in ventilated patients, urinary tract infections, and bacteremia. Both outpatients and hospitalized patients with compromised immune or pulmonary function are also at risk. Acute fulminant infections, such as bacteremic pneumonia, sepsis, burn wound infections, and meningitis are associated with extremely high mortality rates. P. aeruginosa is notorious for its natural resistance to many antibiotics due to the permeability barrier afforded by its gram-negative outer membrane, the presence of antibiotic resistance plasmids, and its tendency to colonize surfaces in a biofilm. While early and aggressive antimicrobial treatment with multiple combinations is often initiated, only a few antibiotics are effective, including fluoroquinolones, aminoglycosides and broader-spectrum beta-lactams; recent reports of emerging resistance to these antimicrobials are concerning.
Salmonellosis is caused by a gram-negative rod that causes food borne gastroenteritis throughout the world. Salmonellosis is commonly contracted through consumption of contaminated food (e.g., meat, poultry, eggs, milk, and green vegetables). While salmonella infection can be a self-limited disease in healthy individuals, treatment may be merited for severe or invasive disease that can occur in the young, elderly and immunocompromised persons. Since the 1990s, strains of salmonella resistant to multiple antimicrobials have emerged and become a serious public health problem. This resistance may be related to the frequent use of antimicrobials both in humans and to promote the growth of food animals.
Like salmonella, shigellosis is caused by a gram-negative rod that is a common cause of gastroenteritis with bloody diarrhea, particularly in the developing world. Salmonellosis is commonly contracted through fecal-oral spread from an infected person or consumption of contaminated food. Shigellosis is particularly common in settings of poor hygiene. Small children are the most likely to get shigellosis and can spread the illness in child care settings and households. Shigella is important from a public health standpoint when community outbreaks occur from contaminated restaurants, food or water supply. Recently, increasing resistance to commonly used antimicrobials for treating shigellosis has been identified, including in outbreak settings.
Enteroccocci are gram-positive cocci that are present in the normal flora of human intestines and are often found in the environment. These bacteria can occasionally cause infections, including infections of the urinary tract, surgical wounds, and central venous catheters, particularly in patients who receive multiple or long-term antimicrobial therapy in the hospital setting. Enterococci can be multi-drug resistant, including to many standard therapies. Recently, certain enterococcal strains have developed increasing resistance to vancomycin, an antibiotic that is important for treatment of both enterococci and methicillin-resistanct staphylococcal infections; these are called vancomycin-resistant enterococci (VRE).
Staphylococcus aureus (S. aureus) are a gram-positive cocci normally present on skin and in the nose. It is a common cause of skin and soft-tissue infections as well as pneumonia, sepsis and a variety of invasive infections. Antibiotic resistant strains of S. aureus have been evolving separately in hospitals and in the community since penicillin was first introduced as a hospital administered drug in the 1940s. Within years, penicillin resistant strains were prevalent in hospitals and were resistant to multiple types of antibiotics, while penicillin resistance did not become significant for another 20 years, following outpatient use of penicillin. Methicillin and related antibiotics were introduced in 1961 to treat penicillin-resistant infections, initially in hospitals. Resistance to methicillin appeared in hospitalized patients the same year the antibiotic was introduced and since then resistance steadily become more common. Methicillin resistance emerged in community strains of S. aureus (MRSA) in the 1990s. While the proportion of methicillin resistance in of healthcare and community associated strains is now similar, susceptibilities for other antibiotics may differ in the two populations. Disturbingly, vancomycin-intermediate S. aureus (VISA) and vancomycin-resistant S. aureus (VRSA) have been reported over the past decade. Although a few VISA have been reported, no VRSA have been documented in California to date.
Streptococcus pneumoniae is a gram-positive coccobacillus that is a major cause of pneumonia, otitis media, sinusitis, peritonitis, arthritis, meningitis and bacteremia. The incidence of serious infection in both adults and children has been decreasing since the introduction of a 7-valent pneumococcal conjugate vaccine in the US in 2001. Prior to the vaccine, seven serotypes (6A, 6B, 9V, 14, 19A, 19F, and 23F) accounted for most drug-resistance S. pneumoniae (DRSP); currently, most antibiotic resistance is found in serotype 19A. Widespread overuse of antibiotics contributes to emerging drug resistance; resistance to the β-lactams and other classes of drugs (e.g.) is increasing.
For questions or comments about the CAL-AP project, please contact us at CDPHCaliforniaAntibiogramProject@cdph.ca.gov