Hospital Antibiograms for Guiding Empiric Therapy

Hospital Antibiograms for Guiding Empiric Therapy

A recent survey of 65 mostly large, academic medical centers across the United States showed great variability in approaches to constructing and reporting antibiograms, even after the NCCLS document was published. Another recent study surveyed U.S. hospitals concerning three basic criteria of the NCCLS guidelines: first, an antibiogram must be provided by the institution for use by clinicians; second, it should be updated annually; and third, it should be distributed to appropriate staff members, including clinicians who prescribe antibiotics, as well as pharmacy, microbiology, and infection control personnel.

With all other limitations of an antibiogram, the major and frontrunner challenges are to make them available, accessible and usable. Technology can prove to be an aid to resolve such problems.

Let us consider developing an online program/form of the Antibiogram Chart that serves as an interactive tool for hospital staff. Broadly, there are some variables in a typical Antibiogram report or Table that serve as key decision points. They are:

1. Bacteria: bacteria name, type, nature, etc
2. Antibiotics: name, type, genre, etc
3. Date: Date of the report
4. Location: Location for which the report is generated (Hospitals/ Wards/Organ Systems like respiratory, circulatory, blood, etc)

Approach : Since the Antibiogram can be hospital-specific, we can create different programs for different hospitals. Each hospital cna be provided with such an online Antibiogen tool that can be updated at designated intervals.  Each hospital can be provided with a hospital id and a password and users from each hospital can login and access the course specific to their hospital using the hospital id and password. Hospitals can directly maintain such an online program or work with a vendor to maintain the tool on their behalf.

Presentation Strategy:

  1. Introduction Screen: The module’s introductory content can be presented with an explicit instruction strategy where learners will be directly presented with the what, why, and where of the Antibiograms, their significance and how to read them.
  2. Summary Screen: The summary will be based on KWL strategy, a structure for recalling what the students know about a topic, noting what the learners need to know, and finally what has been learned so far.
  3. Subsidiary Content Screens: The content on the rest of the screens will be presented with the help of a combination of various instructional strategies such as graphic organizers, advanced organizers, and simple animations that promote active learning. The graphic organizers present a series of thumbnails of graphics of topics about to be discussed. The advanced organizers present a bird’s eye view of the topics to be presented. The simple animated graphics engage and capture the interest of the learners. The visually-rich content enhances the retention of knowledge.
  4. Main Content Screens: The main content screens present a hospital-specific Antibiogram and treatment options for each bacteria based on its susceptibility. The main screen presents a list of bacteria relevant for that hospital. The user can pick and choose the bacteria for which antibiotic and treatment options are required. The second screen displays a list of antibiotics and the susceptibility percentage of that antibiotic on those specific bacteria in a table.  Below the table, a button of ‘Treatment Options’ will be displayed. When the user clicks the button, a third screen will be displayed. The third screen displays the learning specific content to that bacteria/ antibiotic and treatment options in an engaging manner with content and graphics enhancing the presentation. If the user wishes to refer to further information, he/she can choose any of the hyperlinks displayed in the third screen and access reference websites outside the course.