National Guidelines and Statewide Antimicrobial Susceptibility Testing, Reporting and
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National Guidelines and Statewide Antimicrobial Susceptibility Testing, Reporting and Surveillance In Massachusetts. Barbara Bolstorff Kerri Barton Johanna Vostok Hilary Placzek Lynda Glenn Alfred DeMaria Massachusetts Department of Public Health. Antibiograms.

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National Guidelines and Statewide Antimicrobial Susceptibility Testing, Reporting andSurveillance In Massachusetts

Barbara Bolstorff

Kerri Barton

Johanna Vostok

Hilary Placzek

Lynda Glenn

Alfred DeMaria

Massachusetts Department of Public Health


Antibiograms
Antibiograms Susceptibility Testing, Reporting and

  • Antibiograms, generated by hospital microbiology laboratories, report the susceptibility of bacterial isolates tested against specific antibiotics (usually aggregated by year).

  • The Massachusetts Department of Public Health (MDPH) has requested hospitals in Massachusetts send antibiograms since 1999.


Antibiograms in massachusetts
Antibiograms in Massachusetts Susceptibility Testing, Reporting and

  • Since 2002, MDPH has received an average of 53 antibiograms per year (range 43-57) from 71-73 facilities.

  • Organisms routinely reported include:


Antibiogram example
Antibiogram example Susceptibility Testing, Reporting and


Data collection 1999 2011
Data collection 1999-2011 Susceptibility Testing, Reporting and

  • An email is sent to all acute-care hospital microbiology supervisors each year (Feb-March) requesting the previous year’s antibiogram data

  • Prior to electronic submission form (2012)

    • Data were received in a variety of formats, usually through email, fax, or snail mail

    • Missing information (i.e. patient type, duplicate isolate reporting) required a follow-up phone call

    • Data were entered manually into a large Microsoft Office Access Database and analyzed using SAS


Data entry 1999 2011
Data entry 1999-2011 Susceptibility Testing, Reporting and


Clsi clinical and laboratory standards institute
CLSI (Clinical and Laboratory Standards Institute) Susceptibility Testing, Reporting and

  • Documents that provide laboratories with guidance for standardization

    Antibiograms: Developing Cumulative Reports for Your Clinicians:

  • M39-A: 2002

  • M39-A2: 2005

  • M39-A3: 2009

  • M39-A4: ?

    http://www.clsi.org/


Clsi adherence in ma
CLSI adherence in MA Susceptibility Testing, Reporting and

  • MDPH evaluated antibiogram data from 2002-2010

  • Focused on 5 important recommendations from CLSI

    1- Exclude duplicate bacterial isolates (2002)

    2- Separate reporting of Staphylococcus aureus isolates by methicillin (oxacillin)-susceptibility (2002)

    3- Format of data into a grid (2002)

    4- Report species only when 30 or more isolates are tested annually (2005)

    5- Summarize data by patient type (2005)


Reporting of duplicate results and 30 isolates
Reporting of Duplicate Results and <30 Isolates Susceptibility Testing, Reporting and


Reporting a s aureas only mrsa and mssa separately and total plus mrsa and mssa
Reporting a Susceptibility Testing, Reporting andS. aureas only, MRSA and MSSA Separately and Total Plus MRSA and MSSA


Results cont d
Results, cont’d. Susceptibility Testing, Reporting and

  • In 2010, 80% of submitted antibiograms were in a one-page grid format, consistent with the CLSI recommendation

  • Hospitals reporting organisms isolated <30 times per year decreased from 86% in 2002 to 57% in 2010

  • During the time period from 2002 to 2010:

    • Hospitals consistently reported all patient isolates (range: 63-78% )

    • Range of hospitals that reported inpatient only isolates: 22-31%

    • Less than 10% of hospitals reported ICU isolate data separately


Data collection 2012 and beyond
Data collection 2012 and beyond Susceptibility Testing, Reporting and

  • An email is sent to all acute-care hospital microbiology supervisors with a standardizedelectronic submission form

    • Each hospital is asked to enter their data into the form (using Adobe Reader for free) and electronically submit the data via email submission

    • At MDPH: Each form is downloaded from the email, data are extracted using Adobe Acrobat, and analyzed using SAS


2013 submission form
2013 Submission Form Susceptibility Testing, Reporting and


Required fields
Required fields Susceptibility Testing, Reporting and

Electronically submit

to shared email account

Save the form

for later use


Rules built into form
“Rules” built into form Susceptibility Testing, Reporting and


Variable n entry
Variable “N” entry Susceptibility Testing, Reporting and


S pneumoniae reporting
S. pneumoniae Susceptibility Testing, Reporting and reporting


Challenges and lessons learned
Challenges and Lessons Learned Susceptibility Testing, Reporting and

  • IT issues within the hospital laboratory created barriers

    • In most cases, the latest version Adobe Reader had to be downloaded

    • Free program, but IT services do not regularly update laboratories with new programs

  • The new electronic submission process should have been first piloted with a select few “consistent reporters”


Final product
Final Product Susceptibility Testing, Reporting and

  • MDPH creates annual reports for every acute-care hospital in Massachusetts

    • Report shows the state mean susceptibilities of 11 organisms of interest for a variety of antibiotics

    • Hospitals that submit data receive a report showing their hospital-level data compared to the state mean data


Additional data analysis
Additional data analysis Susceptibility Testing, Reporting and

MDPH creates annual reports for every acute-care hospital in Massachusetts

Data monitored over time for trends in susceptibility

S. aureus and oxacillin

E. coli and fluoroquinolones


Staphylococcus aureas susceptibility to oxacillin over time massachusetts antibiograms
Staphylococcus aureas Susceptibility Testing, Reporting and Susceptibility to Oxacillin Over Time, Massachusetts Antibiograms

  • Caveats:

    • Hospitals reporting varies somewhat over time

    • Changes in handling of duplicate isolates


Escherichia coli susceptibility to ciprofloxacin and levofloxacin over time
Escherichia coli Susceptibility Testing, Reporting and Susceptibility to Ciprofloxacin and Levofloxacin Over Time


Standardized data
Standardized data Susceptibility Testing, Reporting and

  • In order to aggregate data across hospitals, antibiograms must be standardized:

    • MRSA and MSSA susceptibilities should be presented separately

    • Report the first isolate tested per patient only (regardless of body site)

    • Report separate tables for gram-negative, gram-positive, and if applicable anaerobic bacteria and yeasts


Clsi guidelines
CLSI Guidelines Susceptibility Testing, Reporting and

  • Standard antimicrobial susceptibility testingand reportingare equally as important

  • CLSI (Clinical Laboratory Standards Institute) for the most up-to-date recommendations:

    • M100-S22: Performance Standards for Antimicrobial Susceptibility Testing; Twenty Second Informational Supplement

    • M39-A3: Antibiograms: Developing Cumulative Reports for Your Clinicians Quick Guide (M39-A3 QG)

      http://www.clsi.org/


Regulatory change
Regulatory Change Susceptibility Testing, Reporting and

  • Proposed requirement for submission of antibiogram data:

    105 CMR 300.171: Reporting of Antimicrobial Resistant Organisms and Cumulative Antibiotic Susceptibility Test Results (Antibiograms)

    (B) All hospitals shall report annual cumulative antibiotic susceptibility test results (antibiograms). This report shall include information specified by the Department and be sent in the manner deemed acceptable by the Department.


Questions
Questions? Susceptibility Testing, Reporting and

Alfred DeMaria Jr., MD

Massachusetts Department of Public Health

[email protected]


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