BACKGROUND: Antibiograms are an important component of antimicrobial stewardship, because they provide a tool for choosing appropriate empirical antibiotics and because they can be used to monitor trends in resistance. Hospitals in Alaska are geographically distant, with several hospitals in Anchorage serving as referral facilities for smaller hospitals. In light of these patterns, there was a request from the Alaska Antimicrobial Stewardship Collaborative to produce regional antibiograms for different areas of the state. The State Healthcare Associated Infections Program was also interested in antibiogram data as a source of information about the epidemiology of antibiotic resistance in Alaska.
METHODS: Antimicrobial stewardship contacts and hospital microbiologists were contacted to obtain their most recent facility antibiograms. Twenty- two hospitals were contacted and 18 were able to provide an antibiogram. Antibiograms were processed, and the cumulative proportion of isolates susceptible to each antibiotic was calculated. Regional antibiograms were then constructed to resemble hospital antibiograms in appearance and interpretation. Comparisons between regions were done for several antibiotic-organism combinations of interest to providers. Comparisons were done using Clopper-Pearson binomial confidence intervals.
RESULTS: Antibiograms for the state of Alaska and for five of six economic regions were constructed. Comparisons between regions were done for fluoroquinolone-resistant Escherichia coli, methicillin-resistant Staphylococcus aureus, and piperacillin-tazobactam-resistant Pseudomonas aeruginosa. Only the proportion of S. aureus resistant to methicillin differed between the regions, with a significantly greater proportion of isolates in the Southwest testing resistant compared to the state average. Antibiograms and results were presented in several webinars and posted on the State Healthcare-Associated Infections Program website. Feedback from users at hospitals was positive and indicated that the antibiograms were useful.
CONCLUSIONS: Regional and state antibiograms based on hospital antibiograms were constructed for the state of Alaska. Some regional differences in susceptibility patterns were noted, but the regions were similar overall. Hospitals indicated that the antibiograms were helpful, as they had larger sample sizes than individual facilities and contained information about species not included in every facility antibiogram. Collecting and analyzing hospital antibiograms was a simple and efficient way of collecting a large amount of information on antibiotic resistance in Alaska.