Los Angeles County Regional Antibiogram: A New Tool for Antibiotic Stewardship March 21, 2018 LADPH, Public Health 1145 Antimicrobial resistance (AR) is a global concern that presents a growing public health challenge. In order to help promote antimicrobial stewardship and reduce AR, the Los Angeles County Department of Public Health (DPH) has created the first LA County regional antibiogram. The Regional Antibiogram Antibiograms, defined as a summary of antimicrobial susceptibility rates for selected bacterial pathogens, provide comprehensive information about local antimicrobial resistance. They are usually generated by a laboratory using aggregate data from a hospital or healthcare system. This first LA County regional antibiogram aggregates voluntary data from 86 facility-level antibiograms to describe countywide patterns of resistance. DPH is using this community antibiogram to monitor and investigate antibiotic resistance across the county. The DPH antibiogram webpage includes tables for gram-negative and gram-positive organisms as well as information on background and methodology. The tables show, for each organism, the percent of isolates that were susceptible to each antibiotic. Click on image to view a full-size sample table. Highlights from the LA County Regional Antibiogram This community antibiogram aggregates facility-level data from 2015. There were several interesting findings including Carbapenem-resistance (CR) among Escherichia coli isolates was lower than expected while CR among Pseudomonas aeruginosa isolates was higher than expected. Clindamycin susceptibility among group B streptococcus was surprisingly low. Further work is being done to better understand these findings. Potential Uses of the Antibiogram Below are three possible uses for the regional antibiogram in health care settings: Guiding antimicrobial selection in serious infections. Within healthcare facilities, information from antibiograms is combined with clinical expertise to guide optimal antimicrobial treatment for patients with carbapenem-resistant enterobacteriaceae (CRE) or other serious infections. Informing empiric therapy selection. Antibiograms can assist health care providers (HCPs) in selecting the best empiric antimicrobial therapy when culture and susceptibility results are not available. Therapy should be adjusted, if indicated, based on microbiology and susceptibility test results. One limitation of this use is that antibiograms do not have standard resistance thresholds.The regional antibiogram may be particularly useful for HCPs in smaller facilities or skilled nursing facilities that do not have a facility antibiogram, as well as for out-of-county facilities who are treating LA County residents. Informing prescribing guidelines. Facilities are also encouraged to review the regional antibiogram at their antibiotic stewardship meetings to inform prescribing guidelines and/or formulary decisions. DPH invites providers to complete a brief survey to give feedback on how the antibiogram will be used and how to improve it. Make sure to subscribe to Rx for Prevention newsletter to stay up-to-date on what's going on with the Los Angeles Department of Public Health.