Analysis and Presentation of Cumulative Antibiograms: A New Consensus Guideline from the Clinical and Laboratory Standards Institute

Hindler, Janet F.; Stelling, John

doi:10.1086/511864

Cited by 228 publications

(207 citation statements)

References 13 publications

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“…Although inconsistent year-to-year variations in susceptibility patterns were noted, none proved to be statistically signifi cant using the Clinical and Laboratory Standards Institute M39-A3 standards. 8,9 This was likely due to relatively small numbers of isolates and changes in susceptibility.…”

Section: Results (Patient Outcomes Metrics) Antimicrobial Susceptibilmentioning

confidence: 99%

Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

et al. 2014

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Background: Antibiotic stewardship has been proposed as an important way to reduce or prevent antibiotic resistance. In 2001, a community hospital implemented an antimicrobial management program. It was successful in reducing antimicrobial utilization and expenditure. In 2011, with the implementation of a data-mining tool, the program was expanded and its focus transitioned from control of antimicrobial use to guiding judicious antimicrobial prescribing. Objective: To test the hypothesis that adding a data-mining tool to an existing antimicrobial stewardship program will further increase appropriate use of antimicrobials. Design: Interventional study with historical comparison. Methods: Rules and alerts were built into the data-mining tool to aid in identifying inappropriate antibiotic utilization. Decentralized pharmacists acted on alerts for intravenous (IV) to oral conversion, perioperative antibiotic duration, and restricted antimicrobials. An Infectious Diseases (ID) Pharmacist and ID Physician/Hospital Epidemiologist focused on all other identifi ed alert types such as antibiotic de-escalation, bug-drug mismatch, and double coverage. Electronic chart notes and phone calls to physicians were utilized to make recommendations. Results: During 2012, 2,003 antimicrobial interventions were made with a 90% acceptance rate. Targeted broad-spectrum antimicrobial use decreased by 15% in 2012 compared to 2010, which represented cost savings of $1,621,730. There were no statistically signifi cant changes in antimicrobial resistance, and no adverse patient outcomes were noted. Conclusions:The addition of a data-mining tool to an antimicrobial stewardship program can further decrease inappropriate use of antimicrobials, provide a greater reduction in overall antimicrobial use, and provide increased cost savings without negatively affecting patient outcomes.

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Section: Results (Patient Outcomes Metrics) Antimicrobial Susceptibilmentioning

confidence: 99%

Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

et al. 2014

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“…by disc diffusion technique of Kirby-Bauer and results were interpreted as per the standard charts provided from the drug supplier (HiMedia, India) (Bauer et al, 1966;Kahn and Line, 2005;Hindler and Stelling, 2007;CLSI, 2013). …”

Section: Susceptibility Of Bacterial Isolates To Antimicrobial Agentsmentioning

confidence: 99%

Bacterial Etiology of Skin and Wound Infections along with Antibiogram Profiling in Reference to Emerging Antibiotic Resistance in Animals

Tiwari¹,

Yadav²,

Singh³

et al. 2015

Adv. Anim. Vet. Sci.

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| The present study demonstrated bacterial etiology of skin affections and their antibiogram profiling of different animal species of various age groups. A total of 255 samples from cattle, buffalo, dogs, goats, sheep, camel and horses were collected over a period of two years (2012)(2013)(2014) from Mathura, (U.P.) India, and nearby surrounding areas. Clinical samples were collected from variety of skin disorders, subjected to laboratory isolation and identification as per standard protocols. The bacterial infection, Staphylococcus aureus, was the most common isolate (36.22 %), followed by E. coli (34.59 %), Pseudomonas (20.54), Bacillus (16.21), Klebsiella (12.43), Micrococcus spp (8.11 %), Streptococcus pyogens (7.56), Proteus (6.49), Clostridium (3.78), Gram negative non-lactose fermenter (2.7%), Gram positive non-spore producing bacilli (2.16) and Fusobacterium (0.54 %). Bacterial isolates obtained were subjected to in vitro antibiotic sensitivity testing by disc diffusion method against 23 commercially available antimicrobial discs. Results of the current study revealed maximum sensitivity to gatifloxacin (94.03%), amikacin (85.7%), mild sensitivity to sparfloxacin (44.85%) and gentamicin (43.48%); emergence of multi-drug resistant bacterial strains of Staphylococcus aureus, Pseudomonas aeruginosa, E.coli appeared to be an important finding. Present study is intended to document the complex microbial inhabitants of wounds from animals and their antimicrobial sensitivity pattern and strongly recommended the use of antimicrobial sensitivity testing to know the rapidly changing pattern of antibiotic activity. The study will further aid to the existing literature for planning new alternative therapeutic strategies against rising global health havoc of multidrug resistance.

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“…At most hospitals combined outpatient and inpatient laboratory data are currently used to create an antibiogram. 10,11 Dahle et al recently examined different susceptibility patterns of urinary isolates in a single health care system, comparing a community based uropathogen antibiogram to a hospital based uropathogen antibiogram for children in Utah. 5 Similar to our findings, they determined that there was a difference in resistance patterns between outpatient and inpatient uropathogens.…”

Section: Discussionmentioning

confidence: 99%

643 a Comparison of Inpatient Versus Outpatient Resistance Patterns in Pediatric Urinary Tract Infection

Saperston¹,

Shapiro

Hersh³

et al. 2013

Journal of Urology

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Purpose-Prior single center studies showed that antibiotic resistance patterns differ between outpatients and inpatients. We compared antibiotic resistance patterns for urinary tract infection between outpatients and inpatients on a national level.Materials and Methods-We examined outpatient and inpatient urinary isolates from children younger than 18 years using The Surveillance Network (Eurofins Scientific, Luxembourg, Luxembourg), a database of antibiotic susceptibility results, as well as patient demographic data from 195 American hospitals. We determined the prevalence and antibiotic resistance patterns of the 6 most common uropathogens, including Escherichia coli, Proteus mirabilis, Klebsiella, Enterobacter, Pseudomonas aeruginosa and Enterococcus. We compared differences in uropathogen prevalence and resistance patterns for outpatient and inpatient isolates using chisquare analysis.Results-We identified 25,418 outpatient (86% female) and 5,560 inpatient (63% female) urinary isolates. Escherichia coli was the most common uropathogen overall but its prevalence varied by gender and visit setting, that is 79% of uropathogens overall for outpatient isolates, including 83% of females and 50% of males, compared to 54% for overall inpatient isolates, including 64% of females and 37% of males (p <0.001). Uropathogen resistance to many antibiotics was lower in the outpatient vs inpatient setting, including trimethoprim/ sulfamethoxazole 24% vs 30% and cephalothin 16% vs 22% for E. coli (each p <0.001), cephalothin 7% vs 14% for Klebsiella (p = 0.03), ceftriaxone 12% vs 24% and ceftazidime 15% vs 33% for Enterobacter (each p <0.001), and ampicillin 3% vs 13% and ciprofloxacin 5% vs 12% for Enterococcus (each p <0.001).Conclusions-Uropathogen resistance rates of several antibiotics are higher for urinary specimens obtained from inpatients vs outpatients. Separate outpatient vs inpatient based antibiograms can aid in empirical prescribing for pediatric urinary tract infections. Antibiotic resistance in pediatric patients is increasing. [1][2][3] Fewer than 50% of all pediatric UTIs are susceptible to commonly used antibiotics. 4 Because identification and susceptibilities are not available at the point of care, antibiograms are useful aids for empirical treatment of UTI while cultures are pending. Hospital based laboratory data combine outpatient and inpatient sensitivity and resistance patterns to generate antibiograms for empirical antibiotic prescribing and yet these data may not accurately reflect uropathogen resistance patterns in outpatients. 3,5,6 Studies from single centers show that antibiotic resistance patterns for pediatric UTI differ by setting with generally higher resistance rates among inpatients than outpatients. Based on these findings these studies suggest that antibiograms should separate data on outpatients from those on inpatients to maximize the usefulness of antibiograms for empirical antibiotic selection for UTI treatment. To our knowledge the extent to which these differences in resis...

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Analysis and Presentation of Cumulative Antibiograms: A New Consensus Guideline from the Clinical and Laboratory Standards Institute

Cited by 228 publications

References 13 publications

Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

Antimicrobial Stewardship in a Community Hospital: Attacking the More Difficult Problems

Bacterial Etiology of Skin and Wound Infections along with Antibiogram Profiling in Reference to Emerging Antibiotic Resistance in Animals

643 a Comparison of Inpatient Versus Outpatient Resistance Patterns in Pediatric Urinary Tract Infection

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