title: Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals.
abstract: Knowledge of local antimicrobial resistance is critical for management of infectious diseases. Community hospitals' compliance with Clinical and Laboratory Standards Institute (CLSI) guidance for creation of cumulative antibiograms is uncertain. This descriptive cohort study of antibiogram reporting practices included community hospitals enrolled in the Duke Infection Control Outreach Network. Cumulative antibiograms from 2012 were reviewed for criteria on reporting practices and compliance with CLSI guidelines. Microbiology personnel were sent a voluntary, electronic survey on antibiogram preparation practices. Data were compiled using descriptive statistics. Thirty-two of 37 (86%) hospitals provided antibiograms; 26 of 37 (70%) also provided survey responses. Twelve (38%) antibiograms specified methods used for compiling data and exclusion of duplicates. Eight (25%) reported only species with >30 isolates. Of the 24 that did not follow the 30-isolate rule, 3 (13%) included footnotes to indicate impaired statistical validity. Twenty (63%) reported at least 1 pathogen-drug combination not recommended for primary or supplemental testing per CLSI. Thirteen (41%) separately reported methicillin-resistant and -susceptible Staphylococcus aureus. Complete compliance with CLSI guidelines was observed in only 3 (9%) antibiograms. Survey respondents' self-assessment of full or partial compliance with CLSI guidelines was 50% and 15%, respectively; 33% reported uncertainty with CLSI guidelines. Full adherence to CLSI guidelines for hospital antibiograms was uncommon. Uncertainty about CLSI guidelines was common. Alternate strategies, such as regional antibiograms using pooled data and educational outreach efforts, are needed to provide reliable and appropriate susceptibility estimates for community hospitals.
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA Duke Infection Control Outreach Network and Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina, USA Durham Veterans Affairs Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA rebekah.moehring@duke.edu.
authors.forename: Rebekah W
authors.initials: RW
authors.lastname: Moehring
authors.affiliation: Duke University Medical Center, Department of Pathology, Durham, North Carolina, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Hazen
authors.affiliation: Duke Infection Control Outreach Network and Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina, USA.
authors.forename: Myra R
authors.initials: MR
authors.lastname: Hawkins
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA Duke Infection Control Outreach Network and Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina, USA Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Drew
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA Duke Infection Control Outreach Network and Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sexton
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina, USA Duke Infection Control Outreach Network and Duke Antimicrobial Stewardship Outreach Network, Durham, North Carolina, USA.
authors.forename: Deverick J
authors.initials: DJ
authors.lastname: Anderson
mesh_terms: D019983:Guideline Adherence; D006302:Health Services Research; D006764:Hospitals, Community; D006801:Humans; D008826:Microbial Sensitivity Tests; D012107:Research Design; D011795:Surveys and Questionnaires