By the Book: Inconsistent Compliance with Clinical and Laboratory Standards Institute’s Antibiogram Guidelines in Community Hospitals
Methods: This is a descriptive cohort study of antibiogram reporting practices in 32 community hospitals enrolled in the Duke Infection Control Outreach Network. We requested 2012 cumulative antibiograms from each facility. Microbiology personnel were sent a voluntary, electronic survey on antibiogram preparation practices. Data on reporting practices and compliance with CLSI guidance were compiled using descriptive statistics.
Results: 32 of 42 (76%) hospitals (median [IQR] bed size 210 [124-280]) participated by providing antibiograms; 21 of 42 (50%) also provided survey responses. The median [IQR] isolate numbers of common species were as follows: E. coli 914 [768-1429], P. aeruginosa 129 [88-184], S. aureus 341 [206-615]. Twelve (38%) antibiograms specified methods used for compiling data and exclusion of duplicates. Eight (25%) reported species with >30 isolates only; 3 (13%) of the 24 who did not follow the 30-isolate rule included a footnote to indicate impaired statistical validity. Twenty (63%) reported at least 1 pathogen-drug combination not recommended for primary or supplemental testing per CLSI (e.g. E. coli and tigecycline). Thirteen (41%) reported methicillin-resistant and susceptible S. aureus separately. Of the 23 facilities that reported susceptibilities for S. pneumoniae, 12 (52%) used meningitis and non-meningitis breakpoints. Complete compliance with CLSI guidance was observed in 3 (9%) antibiograms. Survey respondents’ self-assessment of full or partial compliance with CLSI guidelines was reported by 50% and 17%, respectively. 33% reported uncertainty or unfamiliarity with CLSI guidance.
Conclusion: Full compliance with CLSI guidance for hospital antibiograms was uncommon, largely due to small isolate numbers. Uncertainty about CLSI guidance was common. Alternate strategies, such as regional antibiograms using pooled data, and educational outreach efforts are needed to provide reliable local drug susceptibility estimates for community hospitals.
R. W. Moehring,
R. Drew, None
D. J. Sexton, UpToDate: Editor, Royalties
National Football League: Consultant, Consulting fee and Educational grant
Cubist: Grant Investigator, Grant recipient
Johnson and Johnson: Consultant, Consulting fee
D. Anderson, None
K. C. Hazen, None
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