Antibiogram compliance in University HealthSystem Consortium participating hospitals with Clinical and Laboratory Standards Institute guidelines

Xu, Ran; Polk, Ronald E.; Stencel, Lynda; Lowe, Denise; Guharoy, Roy; Duggal, Raj W.; Wiest, Michelle D.; Putney, Kimberly; Flint, Nora B.

doi:10.2146/ajhp110332

Cited by 29 publications

(24 citation statements)

References 14 publications

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“…Prior published surveys of antibiogram preparation practices have also shown variability in report format and limited uptake of CLSI guidelines (7)(8)(9). Several prior investigators have used self-reported, voluntary surveys to assess compliance with specific CLSI recommendations (7,8,10). A survey of laboratory directors at 494 U.S. acute care hospitals in 2004 reported 60% of responders in compliance with annually compiling, updating, and distributing a facility antibiogram (8).…”

Section: Discussionmentioning

confidence: 99%

“…The self-reported compliance rates in a 2009 survey of pharmacy directors in the University Health Consortium were favorable (10). Respondents reported publishing at least annually (98%), eliminating duplicates (89%), not including surveillance cultures (83%), and including at least 30 isolates for each organism (64%) (10). Studies that assessed compliance by direct inspection of antibiograms showed lower adherence than those that used self-reported compliance (9,11).…”

Section: Discussionmentioning

confidence: 99%

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Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals

et al. 2015

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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...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals

et al. 2015

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“…Prior evaluations have repeatedly demonstrated that stratification of the antibiogram by known risk factors, such as unit (Binkley et al, 2006; Kaufman, Haas, Edinger, & Hollick, 1998; Lalani et al, 2008; Pogue et al, 2011), body site cultured (Green, 2005; Kuster et al, 2008) or relevant patient characteristics (Bosso, Mauldin, & Steed, 2006), may reveal meaningful differences in antibiotic susceptibility patterns. While unit-specific stratification of antibiograms has become increasingly common, a survey of academic and academically-affiliated healthcare systems indicated that only 6% constructed outpatient antibiograms and only 8% constructed pediatric antibiograms (Xu et al, 2012). While outpatient/pediatric antibiograms are not commonly constructed, previous studies suggest that antibiotic susceptibilities among uropathogens do differ significantly between pediatric inpatients and outpatients (Dahle, Korgenski, Hersh, Srivastava, & Gesteland, 2012).…”

Section: Discussionmentioning

confidence: 99%

Variation in Antibiotic Susceptibility of Uropathogens by Age Among Ambulatory Pediatric Patients

McGregor

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Bearden

et al. 2014

Journal of Pediatric Nursing

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We compared uropathogen antibiotic susceptibility across age groups of ambulatory pediatric patients. For Escherichia coli (n=5,099) and other Gram-negative rods (n=626), significant differences (p<0.05) existed across age groups for ampicillin, cefazolin, and trimethoprim/sulfamethoxazole susceptibility. In E. coli, differences in trimethoprim/sulfamethoxazole susceptibility varied from 79% in children under 2 to 88% in ages 16–18 (p<0.001) while ampicillin susceptibility varied from 30% in children under 2 to 53% in ages 2–5 (p=0.015). Uropathogen susceptibility to common urinary anti-infectives may be lower in the youngest children. Further investigation into these differences is needed to facilitate appropriate and prudent treatment of urinary tract infections.

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“…33 These evolving resistance patterns emphasize the importance of understanding the local and regional epidemiology; however, few hospitals report fungal susceptibilities in their antibiograms. 34,35 Correlating antifungal usage with the emergence of antifungal resistance in Candida is beginning to be established. A French multicenter surveillance program evaluated 2,538 candidemia episodes among adults and children over a 7-year period.…”

Section: Emerging Antifungal Resistancementioning

confidence: 99%

Antifungal stewardship considerations for adults and pediatrics

2016

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Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida. Antimicrobial stewardship programs can take a multi-pronged bundle approach to ensure suitable prescribing of antifungals via postprescription review and feedback and/or prior authorization. Institutional guidelines can also be developed to guide diagnostic testing in at-risk populations; appropriate choice, dose, and duration of antifungal agent; therapeutic drug monitoring; and opportunities for de-escalation and intravenous-to-oral conversion.

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Antibiogram compliance in University HealthSystem Consortium participating hospitals with Clinical and Laboratory Standards Institute guidelines

Abstract: Among respondents from 47 UHC hospitals, the compliance rates to four key CLSI recommendations for antibiograms ranged from 64% to 98%. Respondents from 30 hospitals reported significant involvement of pharmacists in compiling, reviewing, and reporting antibiograms.

Cited by 29 publications

References 14 publications

Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals

Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals

Variation in Antibiotic Susceptibility of Uropathogens by Age Among Ambulatory Pediatric Patients

Antifungal stewardship considerations for adults and pediatrics

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