Antimicrobial Stewardship Initiatives: A Programmatic Approach to Optimizing Antimicrobial Use
Robert C. Owens, Paul G. Ambrose, Charles H. Nightingale in Antibiotic Optimization, 2004
The next step is to understand local patterns of antimicrobial resistance, and if possible, to identify relationships with antibiotic usage. Antibiograms are useful to identify trends in antimicrobial resistance and may provide more useful information if community isolates are separated from organisms collected from inpatients. If your hospital is served by an outside commercial laboratory, your antibiogram may be a collection of the laboratory’s customers’ isolates rather than your specific organisms. Further, depending on the size of your institution, drilling down to specific units within the hospital may be of value both in terms of educational feedback to specific units and in identifying areas of the hospital that can be served by specific interventions to change resistance patterns.
The Pharmacist Role in Antimicrobial Stewardship and Interpreting Microbiology Laboratory Results
Nancy Khardori in Bench to Bedside, 2018
In order to determine the appropriate initial therapy, the provider and the pharmacist should first be familiar with the institution’s antibiogram. This tool reports susceptibilities from the previous year within a particular institution and surrounding areas to various antibiotics, empowering the clinician to choose the right presumptive therapy. Typically, the institution’s microbiology laboratory will supply the susceptibility data and will work closely with the infectious disease pharmacist to prepare and distribute the antibiogram. If a gram negative infection is suspected in the hospital setting, common practice is to provide double coverage for Pseudomonas aeruginosa with an anti-pseudomonal beta-lactam, e.g., a carbapenem and either an aminoglycoside or a fluoroquinolone. The pharmacist will recommend to the provider to choose the two most appropriate agents by utilizing the antibiogram. For example, an institution might report 70% sensitivity rate to fluoroquinolones for Pseudomonas aeruginosa, whereas carbapenem or aminoglycosides have sensitivities > 90%. This would illustrate that fluoroquinolones might not be the best initial agent if P. aeruginosa is suspected, as with ventilator-associated pneumonia or septic shock. Moreover, the antibiogram is useful in preparing order-sets to assist the clinician with initial regimens for common infections.
Benchmarking: Its Utility in the Fight Against Antibacterial Resistance
Robert C. Owens, Lautenbach Ebbing in Antimicrobial Resistance, 2007
Until recently, hospitals followed their own set of guidelines for abstracting and presenting data in the form of an antibiogram. However, standardized guidelines to gather, analyze, and present cumulative antimicrobial susceptibility test data in the form of an antibiogram have been published in CLSI document M39-2A (50). Through this guideline, hospitals have a standardized methodology for data extraction for all drugs tested and for reporting results. For example, guidance is given as to which isolates should be included in the analysis (e.g., the first isolate from a patient within an analysis period), the analysis period (at least annual), population tested (e.g., inpatient, intensive care unit, or nursing home), specimen source, and a reasonable minimum of number of isolates for each organism (n = 30). A standardized approach to constructing antibiograms will facilitate internal and external benchmarking of antibacterial resistance patterns. The commitment to collecting antibacterial use and clinical outcome data will further enhance the value of data derived from benchmarking. Such activities will ultimately benefit and support antimicrobial stewardship activities and formulary decisions.
In vitro activity of hyperthermia on swarming motility and antimicrobial susceptibility profiles of Proteus mirabilis isolates
Published in International Journal of Hyperthermia, 2021
Deniz Gazel, Hadiye Demirbakan, Mehmet Erinmez
In the field of clinical microbiology, an antimicrobial susceptibility test (antibiogram) is performed by exposing pathogen bacteria to increasing concentrations of an antibiotic, in vitro. Clinical microbiologists try to isolate and identify bacterial and fungal agents from patient samples using culturing methods. Afterwards, they perform antibiogram tests to determine the minimum inhibitory concentration (MIC) of an antimicrobial drug. If the MIC value is lower than a determined threshold, the isolate is accepted as susceptible/sensitive to that antimicrobial [2,21]. These threshold values (critical breakpoints) are determined by scientific committees for each bacterial/fungal species and antimicrobial drug according to the drug’s achievable concentrations. Nowadays, the Kirby-Bauer disk diffusion method is widely used in clinical microbiology laboratories since it has a strong correlation with reference antibiogram methods and is easy to perform [21]. Similarly, the thermobiogram method can be used to determine the minimum inhibitory temperature (MIT) of an isolate by incubating bacteria in various incubators with increasing temperature levels [2]. After one night of incubation, the lowest temperature value inhibiting the microbial growth can be determined as the MIT. The thermobiogram method can be modified and used to analyze bacterial swarming or synergistic effects of antibiotics at different temperatures.
Effective antibiotic stewardship in spinal cord injury: Challenges and a way forward
Published in The Journal of Spinal Cord Medicine, 2019
Felicia Skelton, Katie Suda, Charlesnika Evans, Barbara Trautner
Our findings raise two follow up questions. First, are SCI/D care providers aware of and utilizing these resources to implement SCI/D-specific antibiotic stewardship programs? Evans and colleagues administered a survey to 118 VHA SCI/D providers (which included physicians, nurse practitioners and physician assistants) querying their knowledge of antibiotic stewardship resources such as facility antibiograms and utilization of ID consult services. An antibiogram is a facility-specific listing of the percent of individual bacterial pathogens susceptible to different antibiotics. They found that nearly one-third of participants responded that they did not have access to or were unaware of a facility antibiogram, and half indicated that they never used antibiograms to determine treatment. However, nearly all (95%) of respondents felt that having access to these resources would reduce antibiotic resistance.14
The war against bacteria, from the past to present and beyond
Published in Expert Review of Anti-infective Therapy, 2022
Lucrezia Bottalico, Ioannis Alexandros Charitos, Maria Assunta Potenza, Monica Montagnani, Luigi Santacroce
An antibiogram screening can be performed on samples obtained from blood (must be performed promptly in positive samples), urines, CSF, biological material from the respiratory tract (sputum, bronchoalveolar lavage), bone or joint specimens, pleural effusions, or fluids from body cavities (when a bacterial etiology is suspected) [215,216]. Besides guiding the correct treatment in single patients, antibiogram can be useful for epidemiological purposes and help to identify hospital infections, which may be antibiotic resistant. On the other hand, results from antibiogram may be meaningless, for example, when the isolated microorganism can reasonably be excluded as responsible for an infection being instead a contaminant or a commensal population (e.g. oral Streptococcus spp. or H. parainfluenzae in a bronchial specimen), or when the number of reported CFU/ml is below a significant threshold in the respective fluid or secretion examined (e.g. urine or bronchial secretions). The second reason is that the isolated pathogen belongs to a species constantly sensitive to standard treatments, or for which there is no correlation between the in vitro and in vivo activity of the drug [216].
Related Knowledge Centers
- Agar Plate
- Antibiotic
- Antimicrobial Resistance
- Bacteria
- Minimum Inhibitory Concentration
- Empiric Therapy
- Directed Therapy
- Medical Laboratory
- Microbiological Culture
- Beta-Lactam