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Khatri D, Falconer N, Coulter S, Gray LC, Paterson DL, Freeman C. Antibiogram development for Australian residential aged care facilities. Infect Control Hosp Epidemiol 2024:1-7. [PMID: 39323353 DOI: 10.1017/ice.2024.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
OBJECTIVE Knowledge of local antibiotic resistance data, provided by antibiograms (a cumulative summary of in vitro-antimicrobial-susceptibility-test results), can aid prescribing of appropriate empirical antibiotics. This study aimed to explore the feasibility of antibiogram development for residential aged care facilities (RACFs). DESIGN Retrospective observational study of culture and sensitivity data. SETTING Nine RACFs in Queensland, Australia. METHOD Available antimicrobial susceptibility results were collected retrospectively for all residents of recruited RACFs from January 1, 2020, to December 31, 2022. Data were managed and analyzed with WHONET software®, and antibiograms were developed in accordance with the CLSI-M39 guidelines. Antibiogram data beyond the standard 12-months and pooling of data from geographically similar RACFs were explored as options to improve feasibility and validity of the antibiograms. RESULTS The most prevalent bacteria in the RACFs were Escherichia coli and Staphylococcus aureus. Due to the low number of positive cultures (less than 30) for individual RACFs, an annual antibiogram was not feasible. Extending the time-period to three years improved feasibility of antibiograms for E.coli in seven RACFs and S.aureus in five RACFs. Combining the data from closely located RACFs allowed for sufficient urinary and skin swab isolates to produce annual pooled antibiograms for all three years. CONCLUSION Use of extended time period antibiograms can provide RACF specific urinary and skin/soft tissue resistance data without the necessity of private pathology provider input. However, pooled syndromic antibiograms can be made available on an annual basis, which may be the preferred option.
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Affiliation(s)
- Dipti Khatri
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Nazanin Falconer
- School of Pharmacy, The University of Queensland & Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia
| | - Sonali Coulter
- Pathology Queensland, Microbiology Queensland Public Health and Scientific Services, Herston, QLD, Australia
| | - Leonard C Gray
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - David L Paterson
- Faculty of Medicine, The University of Queensland, Metro North Hospital and Health Service, Herston, QLD, Australia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Christopher Freeman
- School of Pharmacy and Faculty of Medicine, The University of Queensland, QLD, Australia
- Metro North Hospital and Health Service, Herston, QLD, Australia
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Robillard DW, Sundermann AJ, Raux BR, Prinzi AM. Navigating the network: a narrative overview of AMR surveillance and data flow in the United States. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e55. [PMID: 38655022 PMCID: PMC11036423 DOI: 10.1017/ash.2024.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
The antimicrobial resistance (AMR) surveillance landscape in the United States consists of a data flow that starts in the clinical setting and is maintained by a network of national and state public health laboratories. These organizations are well established, with robust methodologies to test and confirm antimicrobial susceptibility. Still, the bridge that guides the flow of data is often one directional and caught in a constant state of rush hour that can only be refined with improvements to infrastructure and automation in the data flow. Moreover, there is an absence of information in the literature explaining the processes clinical laboratories use to coalesce and share susceptibility test data for AMR surveillance, further complicated by variability in testing procedures. This knowledge gap limits our understanding of what is needed to improve and streamline data sharing from clinical to public health laboratories. Successful models of AMR surveillance display attributes like 2-way communication between clinical and public health laboratories, centralized databases, standardized data, and the use of electronic health records or data systems, highlighting areas of opportunity and improvement. This article explores the roles and processes of the organizations involved in AMR surveillance in the United States and identifies current knowledge gaps and opportunities to improve communication between them through standardization, communication, and modernization of data flow.
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Affiliation(s)
- Darin W. Robillard
- Division of Public Health, University of Utah School of Medicine, Salt Lake City, UT, USA
- Corporate Program Management, bioMérieux, Salt Lake City, UT, USA
| | - Alexander J. Sundermann
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian R. Raux
- US Medical Affairs, bioMérieux, Salt Lake City, UT, USA
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Miesner AR, Williamson B, Bushman AM. AntibiogramDSM: a combined local antibiogram and educational intervention. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e179. [PMID: 38028916 PMCID: PMC10654988 DOI: 10.1017/ash.2023.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 12/01/2023]
Abstract
Objective To describe the development of a combined local antibiogram and assess its utility in an educational intervention. Design Retrospective analysis of a combined, multi-healthcare system antibiogram with an educational intervention and pre-post analysis. Setting Creation of the combined antibiogram included all health systems in Des Moines, Iowa. The educational intervention was delivered live via webinar and remained available on demand for one year. Participants The combined antibiogram participants included four health systems representing eight hospitals. The educational intervention included 45 healthcare providers (15 live, 30 on demand) who elected to participate. Methods Yearly antibiograms were collected from four health systems for 2017 and 2018 and from three health systems for 2019 and 2020. Each was aggregated into a single antibiogram, posted online, and analyzed retrospectively. In 2021, an educational intervention took place, which included pre-educational assessments, a one-hour presentation on local resistance rates and impact on common infections, and post-education assessments. The educational session was available online for one year. Correct responses before and after education were compared using NcNemar's test. Results Over 4 yr, 123,168 isolates were included in the antibiogram, representing 57 species and 46 tested antibiotics. Before education, prediction of local resistance rates for E. coli and S. pneumoniae was poor. After the education session, there was improvement in the proportion of correct responses to case-based questions: pneumonia (31.8% vs 58.8%, P = 0.022), UTI (47.7% vs 85.3%, P < 0.001), sinusitis (75% vs 91.2%, P = 0.109), and diverticulitis (43.2% vs 88.2%, P = 0.002). Conclusions A combined local antibiogram was useful in supporting an outpatient education program.
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Affiliation(s)
- Andrew R. Miesner
- Department of Pharmacy Practice, Drake University College of Pharmacy & Health Sciences, Des Moines, IA, USA
| | | | - Amanda M. Bushman
- Department of Pharmacy, UnityPoint Health – Des Moines, Des Moines, IA, USA
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Bailey P, Antosz K, Daniels R, Gainey AB, Burch AK. Providing value to patients and providers via a pediatric statewide antibiogram in South Carolina. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e78. [PMID: 37113193 PMCID: PMC10127238 DOI: 10.1017/ash.2023.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023]
Abstract
Objective Antimicrobial stewardship has special challenges in particular populations and facilities, including pediatrics. We sought to augment the information available to antimicrobial stewardship programs (ASPs) by created a cumulative statewide antibiogram for neonatal and pediatric populations. Methods In the Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC), we created statewide antibiograms, including a separate antibiogram accounting for the pediatric and neonatal intensive care unit (NICU) populations. We collated data from the 4 pediatric and 3 NICU facilities in the state to provide a cumulative statewide antibiogram. Results Methicillin-susceptible Staphylococcus aureus was more prevalent than methicillin-resistant Staphylococcus aureus. Pseudomonas aeruginosa, Citrobacter koserii, and Acinetobacter baumannii were isolated in only 1 NICU. Conclusions These antibiograms should improve empiric prescribing in both the inpatient and outpatient setting, providing data in some areas that historically do not have pediatric antibiogram to inform prescribing. The antibiogram alone is not sufficient independently to improve prescribing but is one important aspect of stewardship in the pediatric population of South Carolina.
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Affiliation(s)
- Pamela Bailey
- Prisma Health Midlands, Columbia, South Carolina
- University of South Carolina School of Medicine, Columbia, South Carolina
- Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC), Columbia, South Carolina
- Medical University of South Carolina Columbia, Columbia, South Carolina
- Author for correspondence: Pamela Bailey, DO, MPH, Prisma Health, 2 Medical Park, Ste 205, Columbia, SC29204. E-mail: or
| | - Kayla Antosz
- Prisma Health Midlands, Columbia, South Carolina
- Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC), Columbia, South Carolina
- University of South Carolina College of Pharmacy, Columbia, South Carolina
| | - Robert Daniels
- Prisma Health Children’s Hospital–Midlands, Columbia, South Carolina
| | - Andrew B. Gainey
- Prisma Health Children’s Hospital–Midlands, Columbia, South Carolina
| | - Anna Kathryn Burch
- Antimicrobial Stewardship Collaborative of South Carolina (ASC-SC), Columbia, South Carolina
- Prisma Health Children’s Hospital–Midlands, Columbia, South Carolina
- South Carolina Department of Health and Environmental Control (DHEC), Columbia, South Carolina
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Klinker KP, Hidayat LK, Wenzler E, Balada-Llasat JM, Motyl M, DeRyke CA, Bauer KA. 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. Antibiotics (Basel) 2022; 11:antibiotics11050660. [PMID: 35625304 PMCID: PMC9137455 DOI: 10.3390/antibiotics11050660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Antimicrobial resistance is a global public health threat, and gram-negative bacteria, such as Enterobacterales and Pseudomonas aeruginosa, are particularly problematic with difficult-to-treat resistance phenotypes. To reduce morbidity and mortality, a reduction in the time to effective antimicrobial therapy (TTET) is needed, especially among critically ill patients. The antibiogram is an effective clinical tool that can provide accurate antimicrobial susceptibility information and facilitate early antimicrobial optimization, decrease TTET, and improve outcomes such as mortality, hospital length of stay, and costs. Guidance is lacking on how to validate the susceptibility to new antibacterial agents. Commonly used traditional and combination antibiograms may not adequately assist clinicians in making treatment decisions. Challenges with the current susceptibility testing of new β-lactam/β-lactamase inhibitor combinations persist, impacting the appropriate antibacterial choice and patient outcomes. Novel antibiograms such as syndromic antibiograms that incorporate resistant gram-negative phenotypes and/or minimum inhibitory concentration distributions may assist in determining the need for earlier susceptibility testing or help define an earlier optimal use of the new β-lactam/β-lactamase inhibitors. The purpose of this review is to emphasize novel antibiogram approaches that are capable of improving the time to susceptibility testing and administration for new β-lactam/β-lactamase inhibitors so that they are earlier in a patient’s treatment course.
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Affiliation(s)
- Kenneth P. Klinker
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA; (K.P.K.); (L.K.H.); (M.M.); (C.A.D.)
| | - Levita K. Hidayat
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA; (K.P.K.); (L.K.H.); (M.M.); (C.A.D.)
| | - Eric Wenzler
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, 833 South Wood St., Room 164, Chicago, IL 60612, USA;
| | - Joan-Miquel Balada-Llasat
- Department of Clinical Microbiology and Clinical Pathology, The Ohio State University Wexner Medical Center, 181 Taylor Ave., Columbus, OH 43203, USA;
| | - Mary Motyl
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA; (K.P.K.); (L.K.H.); (M.M.); (C.A.D.)
| | - C. Andrew DeRyke
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA; (K.P.K.); (L.K.H.); (M.M.); (C.A.D.)
| | - Karri A. Bauer
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA; (K.P.K.); (L.K.H.); (M.M.); (C.A.D.)
- Correspondence: ; Tel.: +1-614-530-9973
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