Presentation on theme: "Massachusetts Department of Public Health"— Presentation transcript:
1 Massachusetts Department of Public Health National Guidelines and Statewide Antimicrobial Susceptibility Testing, Reporting and Surveillance In MassachusettsBarbara BolstorffKerri BartonJohanna VostokHilary PlaczekLynda GlennAlfred DeMariaMassachusetts Department of Public Health
2 AntibiogramsAntibiograms, generated by hospital microbiology laboratories, report the susceptibility of bacterial isolates tested against specific antibiotics (usually aggregated by year).The Massachusetts Department of Public Health (MDPH) has requested hospitals in Massachusetts send antibiograms since 1999.
3 Antibiograms in Massachusetts Since 2002, MDPH has received an average of 53 antibiograms per year (range 43-57) from facilities.Organisms routinely reported include:Acinetobacter baumanniiStaphylococcus aureusPseudomonas aeruginosaMethicillin-resistant Staphylococcus aureusEscherichia coliKlebsiella pneumoniaeSerratia marcescensStenotrophomonas maltophiliaEnterobacter cloacaeKlebsiella oxytocaEnterobacter aerogenesStreptococcus pneumoniae
7 Data collectionAn is sent to all acute-care hospital microbiology supervisors each year (Feb-March) requesting the previous year’s antibiogram dataPrior to electronic submission form (2012)Data were received in a variety of formats, usually through , fax, or snail mailMissing information (i.e. patient type, duplicate isolate reporting) required a follow-up phone callData were entered manually into a large Microsoft Office Access Database and analyzed using SAS
9 CLSI (Clinical and Laboratory Standards Institute) Documents that provide laboratories with guidance for standardizationAntibiograms: Developing Cumulative Reports for Your Clinicians:M39-A:M39-A2: 2005M39-A3: 2009M39-A4: ?
10 CLSI adherence in MA MDPH evaluated antibiogram data from 2002-2010 Focused on 5 important recommendations from CLSI1- Exclude duplicate bacterial isolates (2002)2- Separate reporting of Staphylococcus aureus isolates by methicillin (oxacillin)-susceptibility (2002)3- Format of data into a grid (2002)4- Report species only when 30 or more isolates are tested annually (2005)5- Summarize data by patient type (2005)
11 Reporting of Duplicate Results and <30 Isolates Exclusion of duplicate bacterial isolates increased from 67% in 2005 to 93% in 2008 and has remained constant.
12 Reporting a S. aureas only, MRSA and MSSA Separately and Total Plus MRSA and MSSA Separate reporting of S. aureus susceptibilities increased from 20% in 2002 to 50% in 2010.
13 Results, cont’d.In 2010, 80% of submitted antibiograms were in a one-page grid format, consistent with the CLSI recommendationHospitals reporting organisms isolated <30 times per year decreased from 86% in 2002 to 57% in 2010During the time period from 2002 to 2010:Hospitals consistently reported all patient isolates (range: 63-78% )Range of hospitals that reported inpatient only isolates: 22-31%Less than 10% of hospitals reported ICU isolate data separately
14 Data collection 2012 and beyond An is sent to all acute-care hospital microbiology supervisors with a standardized electronic submission formEach hospital is asked to enter their data into the form (using Adobe Reader for free) and electronically submit the data via submissionAt MDPH: Each form is downloaded from the , data are extracted using Adobe Acrobat, and analyzed using SAS
20 Challenges and Lessons Learned IT issues within the hospital laboratory created barriersIn most cases, the latest version Adobe Reader had to be downloadedFree program, but IT services do not regularly update laboratories with new programsThe new electronic submission process should have been first piloted with a select few “consistent reporters”Changes to be made: we need to
21 Final ProductMDPH creates annual reports for every acute-care hospital in MassachusettsReport shows the state mean susceptibilities of 11 organisms of interest for a variety of antibioticsHospitals that submit data receive a report showing their hospital-level data compared to the state mean data
22 Give 1-2 examples of staph aureus and e coli state mean susceptibilities and hospital data
24 Additional data analysis MDPH creates annual reports for every acute-care hospital in MassachusettsData monitored over time for trends in susceptibilityS. aureus and oxacillinE. coli and fluoroquinolones24
25 Staphylococcus aureas Susceptibility to Oxacillin Over Time, Massachusetts Antibiograms Caveats:Hospitals reporting varies somewhat over timeChanges in handling of duplicate isolates
26 Escherichia coli Susceptibility to Ciprofloxacin and Levofloxacin Over Time
27 Standardized dataIn order to aggregate data across hospitals, antibiograms must be standardized:MRSA and MSSA susceptibilities should be presented separatelyReport the first isolate tested per patient only (regardless of body site)Report separate tables for gram-negative, gram-positive, and if applicable anaerobic bacteria and yeasts
28 CLSI GuidelinesStandard antimicrobial susceptibility testing and reporting are equally as importantCLSI (Clinical Laboratory Standards Institute) for the most up-to-date recommendations:M100-S22: Performance Standards for Antimicrobial Susceptibility Testing; Twenty Second Informational SupplementM39-A3: Antibiograms: Developing Cumulative Reports for Your Clinicians Quick Guide (M39-A3 QG)
29 Regulatory ChangeProposed requirement for submission of antibiogram data:105 CMR : Reporting of Antimicrobial Resistant Organisms and Cumulative Antibiotic Susceptibility Test Results (Antibiograms)(B) All hospitals shall report annual cumulative antibiotic susceptibility test results (antibiograms). This report shall include information specified by the Department and be sent in the manner deemed acceptable by the Department.
30 Massachusetts Department of Public Health Questions?Alfred DeMaria Jr., MDMassachusetts Department of Public Health