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JAC Advance Access originally published online on October 31, 2006
Journal of Antimicrobial Chemotherapy 2007 59(1):140-143; doi:10.1093/jac/dkl434
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Are laboratory-based antibiograms reliable to guide the selection of empirical antimicrobial treatment in patients with hospital-acquired infections?

Carlos Bantar1,*, Gabriela Alcazar1, Diego Franco1, Francisco Salamone2, Eduardo Vesco3, Teodoro Stieben3, Florencia Obaid3, Alejandro Fiorillo3, Mariano Izaguirre1 and María Eugenia Oliva1

1 Department of Infection Control, Hospital San Martín Perón 450 (3100) Paraná, Entre Ríos, Argentina 2 Department of Microbiology Hospital, San Martín Perón 450 (3100) Paraná, Entre Ríos, Argentina 3 Department of Internal Medicine, Hospital San Martín Perón 450 (3100) Paraná, Entre Ríos, Argentina

Received 19 July 2006; returned 24 August 2006; revised 27 August 2006; accepted 4 October 2006

*Corresponding author. Tel: +54-343-4310783; Fax: +54-343-4232340; E-mail: cbantar{at}arnet.com.ar

Objectives: Antibiograms are often taken into account to define a rational selection of an empirical antimicrobial therapy for treating patients with hospital-acquired infections. In this study, we performed a paired comparison between the antibiogram constructed with laboratory-based data and that formed with data subjected to prior clinical validation.

Methods: Between 2003 and 2005, the laboratory of microbiology printed in duplicate every individual susceptibility report corresponding to hospitalized patients and the copy was sent to the department of infection control. Every individual report was assessed in real time at the bedside of the patient by a multidisciplinary team for clinical significance and appropriateness of the specimen, as well as for the type, source and origin of the infection. Cumulative resistance rates were estimated in parallel at the laboratory with the whole data, and at the infection control department with data subjected to prior clinical validation. These rates were designated as ‘laboratory-based’ and ‘clinically based’, respectively.

Results: A total of 2305 individual susceptibility reports were assessed. Only 1429 (62.0%) were considered as clinically significant by the multidisciplinary team. Escherichia coli, Enterobacter cloacae, Citrobacter freundii group, Klebsiella species and Proteus mirabilis resistant to broad-spectrum cephalosporins, as well as methicillin-resistant Staphylococcus aureus, were significantly more frequent in the clinically based rates (P ≤ 0.03).

Conclusions: Laboratory-based data underestimate the frequency of several major resistant organisms in patients with hospital-acquired infection. Previous clinical validation of the individual susceptibility reports seems to be a suitable strategy to get more reliable data.

Keywords: antibiotics , antimicrobial resistance , susceptibility reports


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