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Optimizing facility-specific urinary weighted-incidence syndromic antibiograms for nursing homes

Published online by Cambridge University Press:  13 January 2026

Lindsay Noelle Taylor Open the ORCID record for Lindsay Noelle Taylor [Opens in a new window] ,
Ronald Gangnon Open the ORCID record for Ronald Gangnon [Opens in a new window] ,
Michael Howe Open the ORCID record for Michael Howe [Opens in a new window] ,
Federico Perez ,
Sally Jolles ,
Jon Furuno Open the ORCID record for Jon Furuno [Opens in a new window] ,
David Nace ,
Robin Jump Open the ORCID record for Robin Jump [Opens in a new window]  and
Christopher Crnich Open the ORCID record for Christopher Crnich [Opens in a new window]
Lindsay Noelle Taylor*
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA William S. Middleton Veterans Affairs Medical Center, Madison, WI, USA University of Wisconsin Hospital and Clinics, Madison, WI, USA
Ronald Gangnon
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Michael Howe
Affiliation:
Department of Wildland Resources, Utah State University, Logan, UT, USA
Federico Perez
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Northeast Ohio Healthcare System, Cleveland, Ohio, USA Division of Infectious Diseases and HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Sally Jolles
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Jon Furuno
Affiliation:
Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, OR, USA
David Nace
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Robin Jump
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Christopher Crnich
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA William S. Middleton Veterans Affairs Medical Center, Madison, WI, USA University of Wisconsin Hospital and Clinics, Madison, WI, USA
*
Corresponding author: Lindsay Noelle Taylor; Email: ltaylor@medicine.wisc.edu
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Abstract

Objective:

To develop an approach for creating facility-specific urinary antibiograms accounting for the low number of isolates recovered in nursing homes (NHs).

Design:

Retrospective analysis of urine culture data collected in NHs in five states.

Setting:

Data on 5097 urine culture isolates collected across 59 study NHs from January 1, 2020 to December 31, 2021. Four consulting microbiology laboratories served the study homes.

Methods:

We compared a Clinical and Laboratory Standards Institute (CLSI) standard antibiogram model to four weighted-incidence syndromic antibiogram (WISCA) models utilizing alternate formatting rules. Ability to produce a facility-specific antibiogram with at least 30 isolates and the impact on susceptibility predictions were compared.

Results:

Only one facility could generate a CLSI standard antibiogram for the three most commonly recovered Gram-negative isolates over a one-year period. Ability to generate an antibiogram increased with each of the four WISCA models trialed (36%, 54%, 85%, 85%) with the most successful models combining all Gram-negative isolates over a two-year period. Shortening the definition of duplicate isolates from 12 to 3 months did not improve performance. Using all Gram-negative isolates, rather than the three most recovered pathogens, resulted in meaningful changes in the predicted activity of ampicillin-sulbactam, cefazolin, ceftriaxone, and trimethoprim-sulfamethoxazole in several study NHs.

Conclusions:

These results suggest that WISCAs using 2-years of urinary culture data including all gram-negative isolates and excluding duplicate isolates within twelve months maximizes the number of NHs able to create a valid antibiogram.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 47 , Issue 3 , March 2026 , pp. 311 - 317
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Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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