Development of a 51-hospital Chicagoland regional antibiogram and comparison to local hospital and national surveillance data

Abstract

Objective: To develop a regional antibiogram within the Chicagoland metropolitan area and to compare regional susceptibilities against individual hospitals within the area and national surveillance data. Design: Multicenter retrospective analysis of antimicrobial susceptibility data from 2017 and comparison to local institutions and national surveillance data. Setting and participants: The analysis included 51 hospitals from the Chicago–Naperville–Elgin Metropolitan Statistical Area within the state of Illinois. Overall, 18 individual collaborator hospitals provided antibiograms for analysis, and data from 33 hospitals were provided in aggregate by the Becton Dickinson Insights Research Database. Methods: All available antibiogram data from calendar year 2017 were combined to generate the regional antibiogram. The final Chicagoland antibiogram was then compared internally to collaborators and externally to national surveillance data to assess its applicability and utility. Results: In total, 167,394 gram-positive, gram-negative, fungal, and mycobacterial isolates were collated to create a composite regional antibiogram. The regional data represented the local institutions well, with 96% of the collaborating institutions falling within ±2 standard deviations of the regional mean. The regional antibiogram was able to include 4–5-fold more gram-positive and -negative species with ≥30 isolates than the median reported by local institutions. Against national surveillance data, 18.6% of assessed pathogen–antibiotic combinations crossed prespecified clinical thresholds for disparity in susceptibility rates, with notable trends for resistant gram-positive and gram-negative bacteria. Conclusions: Developing an accurate, reliable regional antibiogram is feasible, even in one of the largest metropolitan areas in the United States. The biogram is useful in assessing susceptibilities to less commonly encountered organisms and providing clinicians a more accurate representation of local antimicrobial resistance rates compared to national surveillance databases.

Use of Novel Antibiograms to Determine the Need for Earlier Susceptibility Testing and Administration for New β-Lactam/β-Lactamase Inhibitors in the United States

“…One of the most important tools available in assisting with risk stratification and the optimization of empiric antibacterial therapy are antibiograms. Antibiograms provide regionor country-level guidance for appropriate empiric therapy based on resistance patterns within the patient population of an institution, region, or country, but data may not be generalizable to specific patient populations or locations [10,11]. The Clinical and Laboratory Standards Institute M39 provides guidance to microbiology laboratories for the development of an antibiogram to ensure accuracy, reliability, and statistical validity [17].…”

“…Fortunately, there are a variety of tools available to clinicians in assisting with early antimicrobial optimization, decreasing TTET, and improving outcomes such as mortality, length of stay, and costs. One such tool is the antibiogram, which has evolved in its complexity and utility from its traditional version into more modern forms capable of providing more accurate and usable antimicrobial susceptibility information [10,11]. Data from these antibiograms may assist clinicians in making more informed and timely antibacterial susceptibility testing requests for new antibacterial agents for patients.…”

AntibiogramDSM: a combined local antibiogram and educational intervention

“…Prior publications have documented the feasibility of developing cumulative antibiograms at the regional and state levels. [9][10][11] These studies recognize the difficulties associated with combining antibiograms from multiple facilities, including formatting issues, adherence to Clinical Laboratory and Standards Institute (CLSI) guidelines, variation in hospital size and case mix, and isolate testing methods. 1,12 Prior studies combining antibiograms in regions or communities have shown differences from other external-facing surveillance programs such as SENTRY, but have not investigated the clinical utility these tools might have.…”

“…1,12 Prior studies combining antibiograms in regions or communities have shown differences from other external-facing surveillance programs such as SENTRY, but have not investigated the clinical utility these tools might have. 11 We sought to not only create a combined antibiogram for our community but also to find ways to disseminate the data to local providers.…”

Providing value to patients and providers via a pediatric statewide antibiogram in South Carolina

“…7 – 9 Regardless of these limitations, cumulative antibiograms have previously been validated to have meaningful results for communities. 8 , 10 , 11 They are a practical and inexpensive tool to aid clinicians in empiric antimicrobial choices, and with significant clinical significance. 5 , 6 , 10 …”