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ARSTF Workgroup 5 (AR Surveillance Scope)

Dhara Shah, Director of Epidemiology Programs at CSTEBrooke Beaulieu, Surveillance/Informatics Program Analyst at CSTEMarion Kainer, TNDawn Terashita, LA CoScott Troppy, Surveillance Epidemiologist at MA DPHMeredith Lichtenstein, CSTEMichelle Cantu, Director, Infectious Disease & Immunization at NACCHOAllison BrownDJ Shannon, Multidrug-Resistant Organism EpidemiologistMegin NicholsDawn SievertPeter ShultAnna FrickMarisa D'AngeliWHONET Group +19 others
Added by Brooke Beaulieu • Uploaded

Document ColoradoAntibiogram2017_Survey.pdf (51.1 KB)

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Related comments from Colorado:

Here are my thoughts about the antibiogram survey, based on my own experience in Colorado. As was mentioned in the call, there is a hierarchical structure to the questions: 
 Health departments
  1. methods: currently making an antibiogram; source of data (what source and how data are collected); format of data collection (pdf, electronic, etc); method of data entry; format of presentation (web); strata (regions, facility types, etc)
  2. capacity to create an antibiogram: personnelle (type and availability), time, other resources (statistical software)
  3. access to antibiogram data (hospital/lab contacts; who is best to contact)
  4. uses for antibiogram
  5. education after publication
Hospitals/labs
  1. Willingness to provide data
  2. Time available to prepare and submit data
  3. Quality of data (CLSI guidelines)
  4. Utility of the antibiogram to the hospital
We create an antibiogram by collecting facility-specific antibiograms from hospitals and from a single lab that serves many of our nursing homes. We outreached through e-mail and telephone. Hospitals/labs were asked to submit their existing antibiogram and fill out a short survey asking about content and quality (attached). We then entered the data manually into an access database, analyzed the data, and then re-entered the data manually into a table for publication.

 This was a time-consuming process for us, and was limited by quality of the antibiograms submitted to us, and the potential for data entry error. I rationalize that the volume of isolates tested is large and findings less likely to be terribly biased by quality issues in individual antibiograms.
 
The hospitals/labs were most likely to submit their antibiogram if the process was very easy. They would e-mail a pdf. A subset would fill out a short survey (attached), but this seemed to be an unreasonable ask due to time. Fewer responded to the survey this year, even though it was substantially shorter. We contacted hospitals and labs multiple times, first focusing on micro supervisors, then lab supervisors and pharmacists or IPs outside the lab. We didn't encounter any hesitancy to submit data, and time and attention was the major limiting factor.
 
I was concerned about the messaging around the antibiogram once made public, due to the limitations in using aggregated data for clinical use. Therefore, I gave several talks on the antibiogram through hospital and nursing home associations, the QIN/QIO and other. I emphasized that the data were best used for antibiotic stewardship program planning, rather than direct clinical care.
 
I have found the antibiogram a useful tool for stewardship messaging. I hope to survey hospitals to assess the utility to them later this spring. That being said, a process of electronic data collection that requires minimal effort from hospitals, in form consistent with CLSI guidelines (especially de-duplicated), in a format that could easily be analyzed without manual data entry would be ideal.
 
Finally, in addition to the M39, I found the M100 very useful as a guide to choose what antibiotics to present for each organism and when to indicate intrinsic resistance (even if some labs report unfiltered susceptibility data)
 

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Brooke B. posted this on · Download ↓