546 - Antibiogram of bacterial pathogens in neonatal intensive care units in Canada

Poster Number: 546
Publication Number: 546.428

Joseph Ting, University of Alberta, Edmonton, AB, Canada; Jehier Afifi, Dalhousie University Faculty of Medicine, Halifax, NS, Canada; Kyong-Soon Lee, The Hospital for Sick Children, Toronto, ON, Canada; Michael S. Dunn, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Adel Elsharkawy, University of Calgary, Calgary, AB, Canada; Shikha Gupta-Bhatnagar, McMaster Children's Hospital, Hamilton, ON, Canada; Marc-Antoine Landry, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Jennifer Toye, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Jaya Bodani, College of Medicine, University of Saskatchewan/ Regina General Hospital/Saskatchewan Health Authority, Regina, SK, Canada; Melissa J. Chao, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Jocelyn A. Srigley, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Luiz F. Lisboa, University of Calgary, Calgary, AB, Canada; sarah khan, McMaster University Michael G. DeGroote School of Medicine, oakville, ON, Canada; Meghan Donohue, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Mimi Kuan, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Lindsay Richter, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Prakesh Shah, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada; Julie Choudhury, Sunnybrook Health Sciences Centre, Scarborough, ON, Canada; Jessica Minion, Saskatchewan Health Authority, Regina, SK, Canada; Claire L. Hamilton, Alberta Health Services, Calgary, AB, Canada

Background: The neonatal intensive care unit (NICU) is a unique clinical environment that houses neonates who are highly susceptible to overwhelming infections. While antibiograms have been utilized at individual sites, antimicrobial resistance patterns at a national level in Canada has not been reported. A national antibiogram can provide benchmarking and additional guidance to NICUs regarding the optimal empirical antimicrobial coverage for at-risk infants.

Objective: To understand antimicrobial resistance patterns among NICUs in Canada

Design/Methods: We conducted a retrospective study to review antimicrobial resistance patterns from individual tertiary NICUs in Canada. Major bacterial pathogens isolated from blood, cerebrospinal fluid, tracheal/endotracheal aspirates, superficial and deep wound swabs, eye & ear swabs, and urine culture specimens, as collected during clinical care between 2015-2020 were included. Specimens collected for routine screening for antibiotic resistant organisms were excluded. Individual site susceptibility data were collated and utilized to create a combined national antibiogram.

Results: A total of 2575 isolates from nine tertiary NICUs over 1-5 years contributed data to the national antibiogram [Table]. The most frequently isolated organisms were coagulase-negative staphylococci (CoNS) and Staphylococcus aureus. We found < 10% isolates of S. aureus were methicillin-resistant, and none were vancomycin-resistant. None of the 314 Enterococcus strains were vancomycin resistant. The proportion of cefotaxime- and gentamicin-resistant Escherichia coli were < 15% and < 20%, respectively. More than 90% of all other gram-negative bacilli included in this study were susceptible to gentamicin.Conclusion(s): The national antibiogram was able to identify the resistance pattern of commonly identified bacterial pathogens in nine tertiary NICUs in Canada. This provides insight into the adequacy of empirical antibiotic coverage in neonatal sepsis evaluations at a national level. The national antibiogram can be complementary to individual site antibiograms to support the refinement of empirical antibiotic coverage practices across NICUs, and it can also be used over time to assess the impact of various antimicrobial prescription patterns and stewardship programs.
Combined antibiogram from 9 tertiary NICUs in CanadaAMP: ampicillin; CLOX: cloxacillin; VAN: vancomycin; PIP/TAZ: piperacillin/tazobactam; TAX: cefotaxime; TAZ: ceftazidime; GEN: gentamicin; AMK: amikacin; IMI/MER: imipenem/meropenem