title: Detection of antimicrobial resistance by small rural hospital microbiology laboratories: comparison of survey responses with current NCCLS laboratory standards.
abstract: Microbiology laboratory personnel from 77 rural hospitals in Idaho, Nevada, Utah, and eastern Washington were surveyed in July 2000 regarding their routine practices for detecting antimicrobial resistance. Their self-reported responses were compared to recommended laboratory practices. Most hospitals reported performing onsite bacterial identification and susceptibility testing. Many reported detecting targeted antimicrobial resistant organisms. While only 5/61 hospitals (8%) described using screening tests capable of detecting all 8 targeted types of resistance, most (57/61, 93%) were capable of accurately screening for at least 6 types. Conversely, most hospitals (58/61, 95%) reported confirmatory testing capable of identifying only 3 or fewer resistance types with high-level penicillin resistance among pneumococci, methicillin and vancomycin resistance among staphylococci and enterococci, and extended spectrum beta-lactamase production by Gram-negative bacilli presenting the greatest difficulties. Furthermore, only 50% of hospitals compiled annual antibiogram reports to help physicians choose initial therapy for suspected infectious illnesses. This survey suggests that the antimicrobial susceptibility testing in many rural hospitals may be unreliable.
authors.affiliation: Qualis Health, Boise, ID, USA. kurts@qualishealth.org
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Stevenson
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
authors.forename: James
authors.initials: J
authors.lastname: Barbera
authors.forename: James W
authors.initials: JW
authors.lastname: Moore
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hannah
authors.forename: Peter
authors.initials: P
authors.lastname: Houck
authors.forename: Fred C
authors.initials: FC
authors.lastname: Tenover
authors.forename: Julie L
authors.initials: JL
authors.lastname: Gerberding
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects; D006094:Gram-Positive Bacteria / Q000187:drug effects; D019538:Health Care Surveys; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D007755:Laboratories, Hospital / Q000592:standards*; D008826:Microbial Sensitivity Tests / Q000592:standards* / Q000639:trends; D011361:Professional Competence; D011786:Quality Control; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents