Skip to main content
×
×
Home

Demonstration of the Weighted-Incidence Syndromic Combination Antibiogram: An Empiric Prescribing Decision Aid

  • Courtney Hebert (a1), Jessica Ridgway (a2), Benjamin Vekhter (a3), Eric C. Brown (a4), Stephen G. Weber (a2) (a3) and Ari Robicsek (a3) (a4) (a5)...
Abstract
Objective.

Healthcare providers need a better empiric antibiotic prescribing aid than the traditional antibiogram, which supplies no information on the relative frequency of organisms recovered in a given infection and which is uninformative in situations where multiple antimicrobials are used or multiple organisms are anticipated. We aimed to develop and demonstrate a novel empiric prescribing decision aid.

Design/Setting.

This is a demonstration involving more than 9,000 unique encounters for abdominal-biliary infection (ABI) and urinary tract infection (UTI) to a large healthcare system with a fully integrated electronic health record (EHR).

Methods.

We developed a novel method of displaying microbiology data called the weighted-incidence syndromic combination antibiogram (WISCA) for 2 clinical syndromes, ABI and UTI. The WISCA combines simple diagnosis and microbiology data from the EHR to (1) classify patients by syndrome and (2) determine, for each patient with a given syndrome, whether a given regimen (1 or more agents) would have covered all the organisms recovered for their infection. This allows data to be presented such that clinicians can see the probability that a particular regimen will cover a particular infection rather than the probability that a single drug will cover a single organism.

Results.

There were 997 encounters for ABI and 8,232 for UTI. A WISCA was created for each syndrome and compared with a traditional antibiogram for the same period.

Conclusions.

Novel approaches to data compilation and display can overcome limitations to the utility of the traditional antibiogram in helping providers choose empiric antibiotics.

Copyright
Corresponding author
3190 Graves Hall, 333 West 10th Avenue, Columbus, OH 43210 (, courtney.hebert@osumc.edu)
References
Hide All
1. Lee, S, Kim, Y, Chung, DR. Impact of discordant empirical therapy on outcome of community-acquired bacteremic acute pyelonephritis. J Infect 2011;62:159164.
2. Micek, ST, Welch, EC, Khan, J, et al. Resistance to empiric antimicrobial treatment predicts outcome in severe sepsis associated with gram-negative bacteremia. J Hosp Med 2011;6:405410.
3. Zilberberg, MD, Shorr, AF, Micek, ST, et al. Hospitalizations with heathcare-associated complicated skin and skin structure infections: impact of inappropriate empiric therapy on outcomes. J Hosp Med 2010;5:535540.
4. Paul, M, Shani, V, Muchtar, E, Kariv, G, Robenshtok, E, Leibovici, L. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antitnicrob Agents Chemother 2010;54:48514863.
5. Fridkin, SK, Edwards, JR, Courval, JM, et al. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units. Ann Intern Med 2001;135:175183.
6. Mauldin, PD, Salgado, CD, Hansen, IS, Surup, DT, Bosso, JA. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotics-resistant gram-negative bacteria. Antimicrob Agents Chemother 2010;54:109115.
7. Dellit, TH, Owens, RC, McGowan, JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.
8. Christoff, J, Tolentino, J, Mawdsley, E, Matushek, S, Pitrak, D, Weber, SG. Optimizing empirical antimicrobial therapy for infection due to gram-negative pathogens in the intensive care unit: utility of a combination antibiogram. Infect Control Hosp Epidemiol 2010;31:256261.
9. Fox, B, Shenk, G, Peterson, D, Spiegel, C, Maki, D. Choosing more effective antimicrobial combinations for empiric antimicrobial therapy of serious gram-negative rod infections using a dual cross-table antibiogram. Am J Infect Control 2008;36:S57S61.
10. Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arc Intern Med 2003;163:972978.
11. Hindier, JF, Stelling, J. Analysis and presentation of cumulative antibiograms: a new consensus guideline from the Clinical and Laboratory Standards Institute. Clin In fea Dis 2007,44:867873.
12. Jha, AK, DesRoches, CM, Kralovec, PD, Joshi, MS. A progress report on electronic health records in U.S. Hospitals. Health Aff (Milwood) 2010;29:19511957.
13. Department of Health and Human Services. Medicare and Medicaid programs; electronic health record incentive program; proposed rule. Fed Regist 2010;75:18442011.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score