Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-22T04:21:20.999Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of Unit-Specific and Hospital-Wide Antibiograms Potential Implications for Selection of Empirical Antimicrobial Therapy

Published online by Cambridge University Press:  21 June 2016

Shawn Binkley ,
Neil O. Fishman ,
Lori A. LaRosa ,
Ann Marie Marr ,
Irving Nachamkin ,
David Wordell ,
Warren B. Bilker  and
Ebbing Lautenbach
Shawn Binkley
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia
Lori A. LaRosa
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Ann Marie Marr
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia
David Wordell
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Warren B. Bilker
Affiliation:
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Ebbing Lautenbach*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To identify differences between unit-specific and hospital-wide antibiograms and to determine the potential impact of these differences on selection of empirical antimicrobial therapy.

Setting.

A 625-bed tertiary care medical center.

Methods.

Antimicrobial susceptibility results were collected for all inpatient clinical bacterial isolates recovered over a 3-year period; isolates were categorized by the hospital location of the patient at the time of sampling and by the anatomic site from which the isolate was recovered. Antibiograms from each unit were compiled for the most commonly isolated organisms and were compared to the hospital-wide antibiogram.

Results.

A total of 9,970 bacterial isolates were evaluated in this study, including 2,646 enterococcal isolates, 2,806 S. aureus isolates, 2,795 E. coli isolates, and 1,723 Pseudomonas aeruginosa isolates. The percentages of bacterial isolates resistant to antimicrobials were significantly higher in the medical ICU and surgical ICU than the hospital-wide antibiogram would have predicted, whereas the percentages of isolates susceptible to antimicrobials were significantly higher in the non-ICU units, compared with the hospital overall. However, on general medicine units, the prevalence of susceptibility to levofloxacin was significantly lower than that for the hospital overall.

Conclusions.

Unit-specific antibiograms are important for making informed decisions about empirical antimicrobial therapy, because the hospital-wide antibiogram may mask important differences in susceptibility rates across different units. These differences may have important implications for selecting the optimal empirical antimicrobial therapy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 7 , July 2006 , pp. 682 - 687
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ibrahim, EH, Sherman, G, Ward, S, Fraser, VJ, Kollef, MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118:146–155.Google Scholar
2. National Committee for Clinical Laboratory Standards (NCCLS). Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. Wayne, PA: NCCLS; 2002. NCCLS approved standard M39-A.Google Scholar
3. Ernst, EJ, Diekema, DJ, BootsMiller, BJ, et al. Are United States hospitals following national guidelines for the analysis and presentation of cumulative antimicrobial susceptibility data? Diagn Microbiol Infect Dis 2004; 49:141–145.CrossRefGoogle ScholarPubMed
4. Bryce, EA, Smith, JA. Focused microbiological surveillance and gram-negative beta-lactamase-mediated resistance in an intensive care unit. Infect Control Hosp Epidemiol 1995;16:331–334.Google Scholar
5. Stratton, CW, Ratner, H, Johnston, PE, Schaffher, W. Focused microbiologic surveillance by specific hospital unit as a sensitive means of defining antimicrobial resistance problems. Diagn Microbiol Infect Dis 1992; 15: 11S–18S.CrossRefGoogle ScholarPubMed
6. Pierson, CL, Friedman, BA. Comparison of susceptibility to β-lactam antimicrobial agents among bacteria isolated from intensive care units. Diagn Microbiol Infect Dis 1992; 15:19S–30S.CrossRefGoogle ScholarPubMed
7. Kaufman, D, Haas, CE, Edinger, R, Hollick, G. Antibiotic susceptibility in the surgical intensive care unit compared with the hospital-wide antibiogram. Arch Surg 1998; 133:1041–1045.CrossRefGoogle ScholarPubMed
8. Namias, N, Samiian, L, Nino, D, et al. Incidence and susceptibility of pathogenic bacteria vary between intensive care units within a single hospital: implications for empiric antibiotic strategies. J Trauma 2000; 49:638–646.Google Scholar
9. National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. 5th ed. Wayne, PA: NCCLS; 2000. NCCLS approved standard M7-A5, document 2.Google Scholar
10. National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: NCCLS; 2001. NCCLS approved standard M100-S11.Google Scholar
11. Albrich, WC, Angstwurm, M, Bader, L, Gärtner, R. Drug resistance in intensive care units. Infection 1999; 27:19S–23S.Google Scholar
12. Warren, JW, Abrutyn, E, Hebel, JR, Johnson, JR, Schaeffer, AJ, Stamm, WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America. Clin Infect Dis 1999; 29:745–758.Google Scholar
13. Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309–317.Google Scholar