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Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms
Background: An antibiogram is a tool for tracking and reporting antimicrobial resistance; the CDC has endorsed as part of a comprehensive antimicrobial stewardship program in nursing homes. We have previously shown that antibiogram utilization has increased in nursing homes, but most facilities empl...
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| Published in: | Infection control and hospital epidemiology 2020-10, Vol.41 (S1), p.s234-s234 |
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| container_title | Infection control and hospital epidemiology |
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| creator | Taylor, Lindsay Howe, Michael Osman, Fauzia Crnich, Christopher |
| description | Background:
An antibiogram is a tool for tracking and reporting antimicrobial resistance; the CDC has endorsed as part of a comprehensive antimicrobial stewardship program in nursing homes. We have previously shown that antibiogram utilization has increased in nursing homes, but most facilities employ tools that are not based on facility-specific data. In this study, we investigate the feasibility to develop antibiograms using facility-specific data and compare these results with antibiograms developed using data from multiple facilities that share the same lab and geographic region.
Methods:
Raw, de-identified culture results from January 1 through December 31st, 2018 were collected from participating nursing homes and their consulting microbiology laboratories under an IRB-exempt protocol. Culture results were entered and stored in REDCap. Number of isolates per species was examined based on nursing home, nursing home laboratory network, and region. Percentage sensitivities of the most frequently isolated species to commonly used antibiotics were calculated at the nursing home and regional level and compared.
T
tests of the absolute difference between nursing home- and regional level percentage sensitivities were performed. All data analyses were performed in R software.
Results:
The mean annual cultures per nursing home was 23.5 (SE, ±3.29). Grouping cultures by lab and region increased the mean culture count 6-fold and 12-fold, respectively. The most commonly isolated species were
Escherichia coli
(29.7%),
Enterococcus
spp (11.6%),
Proteus
spp (10%),
Klebsiella
spp (8.5%). None of the nursing homes had >30 isolates of a single species (Fig. 1).
Escherichia coli
was the only species that exceeded the 30-isolate threshold when aggregated at the laboratory network level (Fig. 2). Grouping nursing home cultures by region provided the greatest average isolate count across the most common species. The greatest differences in percentage sensitivity between nursing homes and their region were noted for
Escherichia coli
and
Proteus
spp to fluoroquinolones (>20% difference;
P
< .01). The difference in sensitivity was |
| doi_str_mv | 10.1017/ice.2020.786 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2898386729</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2898386729</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1036-bd8ddcb3f518c60fe14d8a7e7f96602db1a716dbcf102e37725fc5dfea7cfabf3</originalsourceid><addsrcrecordid>eNotkMtKAzEYRoMoWKs7H2DArVP_JJ1clqU6ViiKWMFdyORSUqbNmEyFvr1T6-rbHA4fB6FbDBMMmD8E4yYECEy4YGdohKtKlkzQ6TkagZCyFIR-XaKrnDcAwKXEI_ReO51DE9rQH4roi0f349rYhd26WCVtQx_iTrdFrc0fUn50zgQfTPG6T_lILeLWFbNdPzjiOultvkYXXrfZ3fzvGH3WT6v5oly-Pb_MZ8vSYKCsbKyw1jTUV1gYBt7hqRWaO-4lY0BsgzXHzDbGYyCOck4qbyrrnebG68bTMbo7ebsUv_cu92oT92k4mxURUlDBOJEDdX-iTIo5J-dVl8JWp4PCoI7R1BBNHaOpIRr9Bek4YXM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2898386729</pqid></control><display><type>article</type><title>Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms</title><source>Cambridge University Press</source><creator>Taylor, Lindsay ; Howe, Michael ; Osman, Fauzia ; Crnich, Christopher</creator><creatorcontrib>Taylor, Lindsay ; Howe, Michael ; Osman, Fauzia ; Crnich, Christopher</creatorcontrib><description>Background:
An antibiogram is a tool for tracking and reporting antimicrobial resistance; the CDC has endorsed as part of a comprehensive antimicrobial stewardship program in nursing homes. We have previously shown that antibiogram utilization has increased in nursing homes, but most facilities employ tools that are not based on facility-specific data. In this study, we investigate the feasibility to develop antibiograms using facility-specific data and compare these results with antibiograms developed using data from multiple facilities that share the same lab and geographic region.
Methods:
Raw, de-identified culture results from January 1 through December 31st, 2018 were collected from participating nursing homes and their consulting microbiology laboratories under an IRB-exempt protocol. Culture results were entered and stored in REDCap. Number of isolates per species was examined based on nursing home, nursing home laboratory network, and region. Percentage sensitivities of the most frequently isolated species to commonly used antibiotics were calculated at the nursing home and regional level and compared.
T
tests of the absolute difference between nursing home- and regional level percentage sensitivities were performed. All data analyses were performed in R software.
Results:
The mean annual cultures per nursing home was 23.5 (SE, ±3.29). Grouping cultures by lab and region increased the mean culture count 6-fold and 12-fold, respectively. The most commonly isolated species were
Escherichia coli
(29.7%),
Enterococcus
spp (11.6%),
Proteus
spp (10%),
Klebsiella
spp (8.5%). None of the nursing homes had >30 isolates of a single species (Fig. 1).
Escherichia coli
was the only species that exceeded the 30-isolate threshold when aggregated at the laboratory network level (Fig. 2). Grouping nursing home cultures by region provided the greatest average isolate count across the most common species. The greatest differences in percentage sensitivity between nursing homes and their region were noted for
Escherichia coli
and
Proteus
spp to fluoroquinolones (>20% difference;
P
< .01). The difference in sensitivity was <5% for
Escherichia coli
to nitrofurantoin.
Conclusions:
Nursing homes do not generate enough annual isolates to create antibiograms compliant with Clinical Laboratory Standard Institute guidelines. Grouping isolates from multiple nursing homes at the regional level does reliably exceed the 30-isolate threshold for multiple bacterial species but leads to susceptibility estimates that may vary substantially from those observed at the facility level. Alternative tools for tracking antibiotic resistance and guiding antibiotic prescribing decisions at the local level are needed.
Funding:
None
Disclosures:
None</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2020.786</identifier><language>eng</language><publisher>Cambridge: Cambridge University Press</publisher><subject>Antibiotic resistance ; Antibiotics ; Antimicrobial agents ; Disease control ; Drug resistance ; E coli ; Laboratories ; Microbiology ; Nursing homes</subject><ispartof>Infection control and hospital epidemiology, 2020-10, Vol.41 (S1), p.s234-s234</ispartof><rights>2020 by The Society for Healthcare Epidemiology of America. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Taylor, Lindsay</creatorcontrib><creatorcontrib>Howe, Michael</creatorcontrib><creatorcontrib>Osman, Fauzia</creatorcontrib><creatorcontrib>Crnich, Christopher</creatorcontrib><title>Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms</title><title>Infection control and hospital epidemiology</title><description>Background:
An antibiogram is a tool for tracking and reporting antimicrobial resistance; the CDC has endorsed as part of a comprehensive antimicrobial stewardship program in nursing homes. We have previously shown that antibiogram utilization has increased in nursing homes, but most facilities employ tools that are not based on facility-specific data. In this study, we investigate the feasibility to develop antibiograms using facility-specific data and compare these results with antibiograms developed using data from multiple facilities that share the same lab and geographic region.
Methods:
Raw, de-identified culture results from January 1 through December 31st, 2018 were collected from participating nursing homes and their consulting microbiology laboratories under an IRB-exempt protocol. Culture results were entered and stored in REDCap. Number of isolates per species was examined based on nursing home, nursing home laboratory network, and region. Percentage sensitivities of the most frequently isolated species to commonly used antibiotics were calculated at the nursing home and regional level and compared.
T
tests of the absolute difference between nursing home- and regional level percentage sensitivities were performed. All data analyses were performed in R software.
Results:
The mean annual cultures per nursing home was 23.5 (SE, ±3.29). Grouping cultures by lab and region increased the mean culture count 6-fold and 12-fold, respectively. The most commonly isolated species were
Escherichia coli
(29.7%),
Enterococcus
spp (11.6%),
Proteus
spp (10%),
Klebsiella
spp (8.5%). None of the nursing homes had >30 isolates of a single species (Fig. 1).
Escherichia coli
was the only species that exceeded the 30-isolate threshold when aggregated at the laboratory network level (Fig. 2). Grouping nursing home cultures by region provided the greatest average isolate count across the most common species. The greatest differences in percentage sensitivity between nursing homes and their region were noted for
Escherichia coli
and
Proteus
spp to fluoroquinolones (>20% difference;
P
< .01). The difference in sensitivity was <5% for
Escherichia coli
to nitrofurantoin.
Conclusions:
Nursing homes do not generate enough annual isolates to create antibiograms compliant with Clinical Laboratory Standard Institute guidelines. Grouping isolates from multiple nursing homes at the regional level does reliably exceed the 30-isolate threshold for multiple bacterial species but leads to susceptibility estimates that may vary substantially from those observed at the facility level. Alternative tools for tracking antibiotic resistance and guiding antibiotic prescribing decisions at the local level are needed.
Funding:
None
Disclosures:
None</description><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Disease control</subject><subject>Drug resistance</subject><subject>E coli</subject><subject>Laboratories</subject><subject>Microbiology</subject><subject>Nursing homes</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNotkMtKAzEYRoMoWKs7H2DArVP_JJ1clqU6ViiKWMFdyORSUqbNmEyFvr1T6-rbHA4fB6FbDBMMmD8E4yYECEy4YGdohKtKlkzQ6TkagZCyFIR-XaKrnDcAwKXEI_ReO51DE9rQH4roi0f349rYhd26WCVtQx_iTrdFrc0fUn50zgQfTPG6T_lILeLWFbNdPzjiOultvkYXXrfZ3fzvGH3WT6v5oly-Pb_MZ8vSYKCsbKyw1jTUV1gYBt7hqRWaO-4lY0BsgzXHzDbGYyCOck4qbyrrnebG68bTMbo7ebsUv_cu92oT92k4mxURUlDBOJEDdX-iTIo5J-dVl8JWp4PCoI7R1BBNHaOpIRr9Bek4YXM</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Taylor, Lindsay</creator><creator>Howe, Michael</creator><creator>Osman, Fauzia</creator><creator>Crnich, Christopher</creator><general>Cambridge University Press</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope></search><sort><creationdate>202010</creationdate><title>Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms</title><author>Taylor, Lindsay ; Howe, Michael ; Osman, Fauzia ; Crnich, Christopher</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1036-bd8ddcb3f518c60fe14d8a7e7f96602db1a716dbcf102e37725fc5dfea7cfabf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Disease control</topic><topic>Drug resistance</topic><topic>E coli</topic><topic>Laboratories</topic><topic>Microbiology</topic><topic>Nursing homes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Taylor, Lindsay</creatorcontrib><creatorcontrib>Howe, Michael</creatorcontrib><creatorcontrib>Osman, Fauzia</creatorcontrib><creatorcontrib>Crnich, Christopher</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database (Proquest)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Family Health</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Health Management</collection><collection>PML(ProQuest Medical Library)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taylor, Lindsay</au><au>Howe, Michael</au><au>Osman, Fauzia</au><au>Crnich, Christopher</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms</atitle><jtitle>Infection control and hospital epidemiology</jtitle><date>2020-10</date><risdate>2020</risdate><volume>41</volume><issue>S1</issue><spage>s234</spage><epage>s234</epage><pages>s234-s234</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>Background:
An antibiogram is a tool for tracking and reporting antimicrobial resistance; the CDC has endorsed as part of a comprehensive antimicrobial stewardship program in nursing homes. We have previously shown that antibiogram utilization has increased in nursing homes, but most facilities employ tools that are not based on facility-specific data. In this study, we investigate the feasibility to develop antibiograms using facility-specific data and compare these results with antibiograms developed using data from multiple facilities that share the same lab and geographic region.
Methods:
Raw, de-identified culture results from January 1 through December 31st, 2018 were collected from participating nursing homes and their consulting microbiology laboratories under an IRB-exempt protocol. Culture results were entered and stored in REDCap. Number of isolates per species was examined based on nursing home, nursing home laboratory network, and region. Percentage sensitivities of the most frequently isolated species to commonly used antibiotics were calculated at the nursing home and regional level and compared.
T
tests of the absolute difference between nursing home- and regional level percentage sensitivities were performed. All data analyses were performed in R software.
Results:
The mean annual cultures per nursing home was 23.5 (SE, ±3.29). Grouping cultures by lab and region increased the mean culture count 6-fold and 12-fold, respectively. The most commonly isolated species were
Escherichia coli
(29.7%),
Enterococcus
spp (11.6%),
Proteus
spp (10%),
Klebsiella
spp (8.5%). None of the nursing homes had >30 isolates of a single species (Fig. 1).
Escherichia coli
was the only species that exceeded the 30-isolate threshold when aggregated at the laboratory network level (Fig. 2). Grouping nursing home cultures by region provided the greatest average isolate count across the most common species. The greatest differences in percentage sensitivity between nursing homes and their region were noted for
Escherichia coli
and
Proteus
spp to fluoroquinolones (>20% difference;
P
< .01). The difference in sensitivity was <5% for
Escherichia coli
to nitrofurantoin.
Conclusions:
Nursing homes do not generate enough annual isolates to create antibiograms compliant with Clinical Laboratory Standard Institute guidelines. Grouping isolates from multiple nursing homes at the regional level does reliably exceed the 30-isolate threshold for multiple bacterial species but leads to susceptibility estimates that may vary substantially from those observed at the facility level. Alternative tools for tracking antibiotic resistance and guiding antibiotic prescribing decisions at the local level are needed.
Funding:
None
Disclosures:
None</abstract><cop>Cambridge</cop><pub>Cambridge University Press</pub><doi>10.1017/ice.2020.786</doi><oa>free_for_read</oa></addata></record> |
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| language | eng |
| recordid | cdi_proquest_journals_2898386729 |
| source | Cambridge University Press |
| subjects | Antibiotic resistance Antibiotics Antimicrobial agents Disease control Drug resistance E coli Laboratories Microbiology Nursing homes |
| title | Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms |
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