e Knowledge of local antimicrobial resistance is critical for management of infectious diseases. Community hospitals' compliance with Clinical and Laboratory Standards Institute (CLSI) guidance for creation of cumulative antibiograms is uncertain. This descriptive cohort study of antibiogram reporting practices included community hospitals enrolled in the Duke Infection Control Outreach Network. Cumulative antibiograms from 2012 were reviewed for criteria on reporting practices and compliance with CLSI guidelines. Microbiology personnel were sent a voluntary, electronic survey on antibiogram preparation practices. Data were compiled using descriptive statistics. Thirty-two of 37 (86%) hospitals provided antibiograms; 26 of 37 (70%) also provided survey responses. Twelve (38%) antibiograms specified methods used for compiling data and exclusion of duplicates. Eight (25%) reported only species with >30 isolates. Of the 24 that did not follow the 30-isolate rule, 3 (13%) included footnotes to indicate impaired statistical validity. Twenty (63%) reported at least 1 pathogen-drug combination not recommended for primary or supplemental testing per CLSI. Thirteen (41%) separately reported methicillin-resistant and -susceptible Staphylococcus aureus. Complete compliance with CLSI guidelines was observed in only 3 (9%) antibiograms. Survey respondents' self-assessment of full or partial compliance with CLSI guidelines was 50% and 15%, respectively; 33% reported uncertainty with CLSI guidelines. Full adherence to CLSI guidelines for hospital antibiograms was uncommon. Uncertainty about CLSI guidelines was common. Alternate strategies, such as regional antibiograms using pooled data and educational outreach efforts, are needed to provide reliable and appropriate susceptibility estimates for community hospitals. F acility-specific cumulative antibiograms serve several important purposes in the care of patients with infectious diseases. For clinicians, knowledge of local drug resistance rates improves the selection of empirical antibiotics prior to return of culture and susceptibility results. In addition, cumulative susceptibility data are used to track changes in resistance over time, perform surveillance for emergence of drug-resistant organisms, and identify areas for intervention by hospital infection prevention and antimicrobial stewardship programs (1). For example, the Centers for Disease Control and Prevention includes two functions of the cumulative antibiogram as "core" elements of hospital antimicrobial stewardship programs: (i) tracking antimicrobial resistance and (ii) regular reporting of information on antibiotic resistance to relevant hospital staff (2). Cumulative antibiogram preparation and distribution are considered an essential function of the clinical microbiology laboratory (3). Antibiogram data can also improve hospital antibiotic formulary decisions and local protocols such as surgical prophylaxis or empirical treatment guidelines.The Clinical and Laboratory Standards Institute (CLSI) first provided...

The purpose of this study was to compare a variety of local anesthetic agents before starting an intravenous (i.v.) device to determine which method is the most comfortable for patients. Using a randomized, double-blind, placebo-controlled, pretest-posttest experimental design, the study compared 5 treatment groups (anesthetic spray, placebo spray, anesthetic intradermal injection, placebo intradermal injection, and a control group with no local anesthetic agent) in 84 emergency department patients. Pain was measured with a visual analog scale before and after the application of the local anesthetic agents and after i.v. insertion. Pain was significantly higher in the anesthetic intradermal injection group 1 minute after anesthetic application compared with the other treatment groups. Pain ratings 3 minutes after i.v. insertion were found to be similar for the 5 treatment groups. These study results do not support the use of intradermal anesthetic agents before i.v. catheter insertion.

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