Diagnostic Accuracy of Hospital Antibiograms in Predicting the Risk of Antimicrobial Resistance in Enterobacteriaceae Isolates: A Nationwide Multicenter Evaluation at the Veterans Health Administration

Shinya Hasegawa; Daniel Livorsi; Eli N Perencevich; Jonas N Church; Michihiko Goto

doi:10.1093/cid/ciad467

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Diagnostic Accuracy of Hospital Antibiograms in Predicting the Risk of Antimicrobial Resistance in Enterobacteriaceae Isolates: A Nationwide Multicenter Evaluation at the Veterans Health Administration

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Diagnostic Accuracy of Hospital Antibiograms in Predicting the Risk of Antimicrobial Resistance in Enterobacteriaceae Isolates: A Nationwide Multicenter Evaluation at the Veterans Health Administration

Shinya Hasegawa, Daniel Livorsi, Eli N Perencevich, Jonas N Church and Michihiko Goto

Clinical infectious diseases, Vol.77(11), pp.1492-1500

12/01/2023

DOI: 10.1093/cid/ciad467

PMCID: PMC11487110

PMID: 37658908

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Abstract

Abstract Background Many clinical guidelines recommend that clinicians use antibiograms to inform empiric antimicrobial therapy. However, hospital antibiograms are typically generated by crude aggregation of microbiologic data, and little is known about an antibiogram’s reliability in predicting antimicrobial resistance (AMR) risk at the patient-level. We aimed to assess the diagnostic accuracy of antibiograms as a tool for selecting empiric therapy for E. coli and Klebsiella spp. for individual patients. Methods We retrospectively generated hospital antibiograms for the nationwide Veterans Health Administration (VHA) facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli and Klebsiella spp., then assessed the diagnostic accuracy of an antibiogram to predict resistance for isolates in the following calendar year using logistic regression models and predefined 5-step interpretation thresholds. Results Among 127 VHA facilities, 1,484,038 isolates from 704,779 patients for E. coli and 671,035 isolates from 340,504 patients for Klebsiella spp. were available for analysis. For E. coli and Klebsiella spp., the discrimination abilities of hospital-level antibiograms in predicting individual patient AMR were mostly poor, with the areas under the receiver operating curve at 0.686 and 0.715 for ceftriaxone, 0.637 and 0.675 for fluoroquinolones, and 0.576 and 0.624 for trimethoprim-sulfamethoxazole, respectively. The sensitivity and specificity of the antibiogram varied widely by antimicrobial groups and interpretation thresholds with substantial trade-offs. Conclusions Conventional hospital antibiograms for E. coli and Klebsiella spp. have limited performance in predicting AMR for individual patients, and their utility in guiding empiric therapy may be low.

Details

Title: Subtitle: Diagnostic Accuracy of Hospital Antibiograms in Predicting the Risk of Antimicrobial Resistance in Enterobacteriaceae Isolates: A Nationwide Multicenter Evaluation at the Veterans Health Administration
Creators: Shinya Hasegawa - University of Iowa
Daniel Livorsi - Iowa City VA Health Care System
Eli N Perencevich - Iowa City VA Health Care System
Jonas N Church
Michihiko Goto - Iowa City VA Health Care System
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.77(11), pp.1492-1500
DOI: 10.1093/cid/ciad467
PMID: 37658908
PMCID: PMC11487110
NLM abbreviation: Clin Infect Dis
ISSN: 1058-4838
eISSN: 1537-6591
Grant note: DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality, award: K08HS027472
Language: English
Electronic publication date: 08/10/2023
Date published: 12/01/2023
Academic Unit: Infectious Diseases; Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984455539902771

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