1778. Exploring Bacterial Resistance in Northern Oman, a Stewardship Initiative to Improve Antibiotic Prescription

BACKGROUND: Surveillance and characterization of bacterial isolates are the preliminary approaches to optimize the use of antibiotics and guide both clinical and institutional decisions surrounding the perspicacious use of antibiotics. We sought to describe the local prevalence of bacterial resistance to direct our stewardship interventions. METHODS: ResearchApproval was obtained from Ministry of Health, Sultanate of Oman. We surveyed all bacterial isolates collected by microbiology laboratory of Sohar Hospital (450-bed tertiary care facility serving patients of northern Oman) between January 1, 2016 to December 31, 2017. Acquired data included; patient demographics, requesting ward, relevant dates (admission, discharge, sample request and collection, result release), specimen type, isolate identification, and sensitivity. Samples from the same patient collected within less than a week with identical phenotype were excluded. RESULTS: Isolates (n = 15,733) were Gram-positive 29%, Gram-negative 67%, Candida species 23%, other fungi 0.3%, mycobacteria 0.4%. Of Gram-positive group, Staphylococcus aureus (MSSA 27% and MRSA16%), S. agalactiae 25%, coagulase negative staphylococci 12% and others (18 organisms) 19%. Vancomycin was active against 99% of tested isolates. Of Gram-negative group, E. coli 32%, P. aeruginosa 22%, K. pneumoniae 19%, A. baumannii 5%, P. mirabilis 4%, and others (57 organisms) 13%. Extended spectrum β-lactamase production was detected in 12% of cases, while phenotypic colorimetric testing revealed 4% carbapenemase production. Critical care units accommodated 70% of cases with carbapenem resistance infections consisting of 43% pneumonia, 27% blood stream infections, and 12% urinary tract infections. CONCLUSION: Vancomycin resistance is limited, cefazolin, and other β-lactams are appropriate empirical agents for a wide range of cases, adequate vancomycin dosing and monitoring should be emphasized to hinder resistance development. Increasing number of carbapenem-resistant cases are being encountered, necessitating consideration of early detection and treatment, appropriate alternative agents and combinations, in addition to a multi-disciplinary approach to treat these recalcitrant infections. DISCLOSURES: All authors: No reported disclosures.