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Comparison of Unit-Specific and Hospital-Wide Antibiograms Potential Implications for Selection of Empirical Antimicrobial Therapy

Published online by Cambridge University Press:  07 April 2017

Shawn Binkley
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia
Lori A. LaRosa
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Ann Marie Marr
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia
David Wordell
Affiliation:
Department of Pharmacy, University of Pennsylvania School of Medicine, Philadelphia
Warren B. Bilker
Affiliation:
Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
Ebbing Lautenbach*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 (elautenb@cceb.med.upenn.edu)

Abstract

Objective.

To identify differences between unit-specific and hospital-wide antibiograms and to determine the potential impact of these differences on selection of empirical antimicrobial therapy.

Setting.

A 625-bed tertiary care medical center.

Methods.

Antimicrobial susceptibility results were collected for all inpatient clinical bacterial isolates recovered over a 3-year period; isolates were categorized by the hospital location of the patient at the time of sampling and by the anatomic site from which the isolate was recovered. Antibiograms from each unit were compiled for the most commonly isolated organisms and were compared to the hospital-wide antibiogram.

Results.

A total of 9,970 bacterial isolates were evaluated in this study, including 2,646 enterococcal isolates, 2,806 S. aureus isolates, 2,795 E. coli isolates, and 1,723 Pseudomonas aeruginosa isolates. The percentages of bacterial isolates resistant to antimicrobials were significantly higher in the medical ICU and surgical ICU than the hospital-wide antibiogram would have predicted, whereas the percentages of isolates susceptible to antimicrobials were significantly higher in the non-ICU units, compared with the hospital overall. However, on general medicine units, the prevalence of susceptibility to levofloxacin was significantly lower than that for the hospital overall.

Conclusions.

Unit-specific antibiograms are important for making informed decisions about empirical antimicrobial therapy, because the hospital-wide antibiogram may mask important differences in susceptibility rates across different units. These differences may have important implications for selecting the optimal empirical antimicrobial therapy.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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