New Drugs for Bad Bugs- Statewide Antibiogram

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1 New Drugs for Bad Bugs- Statewide Antibiogram Felicia Matthews, Pharm.D., BCPS Senior Consultant, Pharmacy Specialty BE MedMined Services

2 Disclosures Employee of BD Corporation MedMined Services

3 Agenda Antimicrobial Resistance New Drugs to Combat Emerging Resistance Updates to Regulation for Antimicrobial Stewardship Statewide Antibiogram Antibiotics

4 Antimicrobial Resistance Antibiotic resistant infections add considerable and avoidable cost to the U.S. health care system: Up to: direct cost lost productivity

5 Antimicrobial Resistance 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

6 Antimicrobial Resistance Urgent Threat Clostridium Difficle (C. Diff) Carbapenem-Resistant Enterobacteriaceae (CRE) Serious Threat Multidrug-Resistant Acinetobacter Extended Spectrum Enterobacteriaceae Vancomycin Resistant Enterococcus Multidrug-Resistant Pseudomonas Aeruginosa Methicillin-Resistant Staphylococcus Aureus (MRSA)

7 Antimicrobial Resistance

8 Antimicrobial Resistance Prevention & Control Testing Treatment

9 Antimicrobial Resistance

10 Antimicrobial Resistance

11 New Treatment Options: Gram Positive Agents Drug Indication Coverage Approval Date Comments/Opinions Dalbavancin (Dalvance ) Oritavancin (Orbactiv ) ABSSSI MRSA 2014 Bactericidal 1-2 dose regimen ABSSSI MRSA, VRE 2014 Bactericidal One time dosing Contraindicated with heparin Tedizolid (Sivextro ) ABSSSI MRSA, VRE 2014 Bactericidal Prodrug IV/PO dosing Delafloxacin (Baxdela ) ABSSSI MRSA 2017 Bactericidal Polymicrobial ABSSSI

12 Pipeline for Gram Positive Agents

13 Pipeline for Gram Positive Agents

14 New Treatment Options: Gram Negative Agents

15 Pipeline for Gram Negative Agents 2017 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company.

16 Regulatory Joint Commission ASP Standard MM Effective since January Organization must have a policy that address each core element in the ASP. Currently there is not any specific data that should be collected, analyzed or reported. Your organization must show improvement opportunities based on the collected and data analyzed.

17 Regulatory Joint Commission ASP Standard MM Providing written material such as the organizations antibiogram will meet the education requirement. Organizations may receive a requirement for improvement if there is not a physician on the team. They will not be reviewing staff records on education received regarding antimicrobial stewardship.

18 Regulatory CMS Conditions of Participation for Long Term Care Facilities (LTC) CMS Medicare Beneficiary Quality Improvement Project (MBQIP) CMS Conditions of Participation for Critical Access Hospitals (CAHs)

19 AHQI Antibiogram

20 What is included? Isolates from 56 hospitals in Alabama Includes data from 1/2017 to 12/2017 One isolate per organism per 365 day period Duplicate isolates removed Significantly different susceptibility results are considered unique or nonduplicate

21 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

22 Hospital Enterococcus Isolates (Non-Urine) % (31%) of Enterococcus isolates are the more resistant faecium strain 1122 E Faecium E Faecalis

23 Vancomycin Resistant E Faecium (Hospital Non-Urine) % E. faecium resistant to vancomycin is unchanged from last year 80% (80%) Vancomycin Linezolid E. faecium resistance to linezolid is unchanged from last year 6% (6%). Still below 2007 levels % * 95% of E. faecalis remain susceptible to vancomycin

24 Hospital MRSA (Non-Urine) % MRSA has been flat since about 2012 and is at 58% in The percent remains high relative to other regions in the US

25 MRSA All HAIs

26 MRSA Hospital versus Community (Non-Urine) % Lines appear to be separating since 2013 as hospital is about 5% more resistance % Hospital Community Community will include patients from nursing homes and long-term care hospitals and may not reflect Community in the traditional sense. 40

27 Klebsiella pneumonia Isolates Resistant to Meropenem (KPC) total 106 total 105 total (n=6267) 2016 (n=6310) 2017 (n=7015) Comm Hosp 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 testing against meropenem increased to 7015 (6310) but total resistant isolates remained flat. There was an increase in community resistant strains but a decrease in hospital resistant strains.

28 Hospital Non-Urine A. baumannii Isolates Susceptible to Meropenem 100% 90% 80% 70% 60% 50% 40% 78 64% 92 70% % % drop in susceptibility reported in A. baumannii has always been difficult to treat so infection prevention is critical. Multi-drug Resistant A. baumannii is associated with high mortality and is difficult to treat. 30% 20% 10% 0% Combination therapy of carbapenem with ampicillin/sulbactam, colistin or tigecycline still may be necessary Total Isolates % Susceptible

29 Carbapenms R or I Acinetobacter NATIONAL HAIs

30 Hospital P. aeruginosa Non-Urine Cefepime Aztreonam Pip/Tazo 85% 82% B-Lactams Pipercillin/Tazobactam and Cefepime continue to be stable Drop in Aztreonam 60% (66%) marks the first decline the last 5 years 60 60% 50

31 Hospital P. aeruginosa Non-Urine % 90% 81% Aminoglycosides Amikacin and Tobramycin steady at over 90% Gentamicin continues to improve over the last 5 years Amikacin Tobramycin Gentamicin 50

32 100 Hospital P. aeruginosa Non-Urine Carbapenems Imipenem Meropenem 76% 71% P. aeruginosa susceptibility to imipenem and meropenem improve respectively at 71% (68%) and 76% (73%). There is still concern here as this one of our last lines of defense against resistant gram negative bacteria.

33 Hospital P. aeruginosa Non-Urine Levofloxacin Quinolones Poor activity against Pseudomonas but there is a trend towards improvement over the past 4 years and since %

34 Antibiogram Summary Enterococcus faecium resistant to vancomycin or linezolid, hospital non-urine, remains stable (80%, 6%) MRSA, hospital non-urine, is flat. Geographically, still high. Appears that MRSA, community non-urine, is declining slightly faster. CRKP, hospital and community, was flat in 2017, however the make-up changed with more of the resistant strains coming from the community setting. A. baumannii, hospital non-urine, big drop in susceptibility (53% vs 70%). Preventing the infection is critical. P. aeruginosa, hospital non-urine, resistance to carbapenems flat although still a concern.

35 Antibiotic National Comparison Antibiotics 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

36 Antibiotic National Comparison Carbapenems 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

37 Antibiotic National Comparison Piperacillin / Tazobactam 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

38 Antibiotic National Comparison Quinolones 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

39 Antibiotic National Comparison 3 rd /4 th Generation Cephalosporins 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

40 Antibiotic National Comparison Vancomycin, Linezolid, Daptomycin, Tigercycline 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

41 Antibiotic National Comparison Proton Pump Inhibitors 2018 BD. BD, the BD Logo and MedMined are trademarks of Becton, Dickinson and Company

42 New Drugs for Bad Bugs- Statewide Antibiogram Felicia Matthews, Pharm.D., BCPS Senior Consultant, Pharmacy Specialty BE MedMined Services

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

Antimicrobial Stewardship/Statewide Antibiogram. Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services Antimicrobial Stewardship/Statewide Antibiogram Felicia Matthews Senior Consultant, Pharmacy Specialty BD MedMined Services Disclosures Employee of BD Corporation MedMined Services Agenda CMS and JCAHO

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