Using hospital data to generate facility-specific antibiogram for a private hospital in the Western Cape

Abstract

Fundamental information for a facility can be provided by identifying the prevalent pathogens and their susceptibility profile to antimicrobial agents. The aim of this study was to provide information about the prevalence and local susceptibility patterns of pathogens presented in the form of a cumulative antibiogram. Two databases, viz. PathProvider® V.1.4.2 and ICNet® Clinical Surveillance Software was used in order to perform a quantitative, observational, descriptive, cross-sectional study by collecting retrospective data from existing medical data records. The study took place at a private facility positioned in Worcester in the Inland and Coastal District of the Western Cape of South Africa. The study population consisted of all patients aged 18 years and older admitted to the critical care, medical, orthopaedic and surgical units of the hospital during the study period of 1 January 2014 to 31 December 2015. A total of 1424 pathogens were isolated in the hospital of which 63.7% (n = 908) represented gram-negative organisms and 36.2% (n = 516) gram-positive organisms. Escherichia coli (34.5%) was the most prevalent organism among gram-negative and methicillin-susceptible Staphylococcus aureus (MSSA) (31%) the most prevalent among gram-positive organisms. A total of 192 pathogens were isolated in the critical care unit; the three most prevalent organisms were Escherichia coli (n = 34), Klebsiella pneumoniae (n =15) and Enterococcus faecalis (n = 13). In the medical unit a total of 408 pathogens were isolated, where Escherichia coli (n = 93), Haemophilus parainfluenzae (n = 40), and Klebsiella species (spp.) (n = 27) were the most prevalent. In the orthopaedic- and the surgical units a total of 288 and 536 organisms were isolated, respectively. Escherichia coli (n = 55 for orthopaedic and n = 104 for surgical), MSSA (n = 55 for orthopaedic and n = 78 for surgical) and Enterococcus faecalis (n = 22 for orthopaedic and n = 43 for surgical) were the most prevalent organisms. The cumulative antibiogram generated for the facility included pathogens that were isolated 30 times or more in total in the specific units of the hospital and were presented in separate tables for gram-negative and gram-positive organisms as recommended by the Clinical and Laboratory Standards Institute (CLSI). Species that had fewer than 30 isolates, i.e. Acinetobacter spp., coagulase-negative Staphylococcus spp. and methicillin-resistant Staphylococcus spp. were morphologically grouped together in the antibiogram. Escherichia coli had enough isolates to separate urine isolates from non-urine isolates. The study demonstrated resistance among multi-drug resistant organisms for the hospital. Carbapenem resistance among Pseudomonas aeruginosa and Acinetobacter spp. was confirmed. Surveillance studies should be done continually in order to monitor resistant patterns of these pathogens.