Controversies in Care| Volume 19, ISSUE 9, P744-747, September 2018

Antimicrobial Stewardship in Long-Term Care Facilities: Approaches to Creating an Antibiogram when Few Bacterial Isolates Are Cultured Annually

  • Maria-Stephanie A. Tolg
    Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI

    Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI
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  • David M. Dosa
    Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI

    Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI

    Warren Alpert Medical School of Brown University, Providence, RI
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  • Robin L.P. Jump
    Geriatric Research Education and Clinical Center (GRECC) and the Specialty Care Center of Innovation at the Louis Stokes Cleveland, Department of Veterans Affairs Medical Center, Cleveland, OH

    Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH
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  • Angelike P. Liappis
    Section of Infectious Diseases, Washington DC Veterans Affairs Medical Center, Washington DC
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  • Kerry L. LaPlante
    Address correspondence to Kerry L. LaPlante PharmD, FCCP, FIDSA, University of Rhode Island, College of Pharmacy, 7 Greenhouse Rd, Suite 295A, Kingston, RI 02881.
    Veterans Affairs Medical Center, Infectious Diseases Research Program, Providence, RI

    Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI

    Warren Alpert Medical School of Brown University, Providence, RI
    Search for articles by this author


      Antibiograms are important clinical tools to report and track antibiotic susceptibility and help guide empiric antimicrobial therapy. Antibiograms support compliance with antimicrobial stewardship (AMS) requirements from the Centers for Medicare and Medicaid Services and are in line with recommendations from the Centers for Disease Control and Prevention Core Elements of AMS for nursing homes/long-term care facilities (LTCFs). Unlike most acute-care settings, LTCFs are challenged in creating antibiograms because of the low number of bacterial isolates collected annually. Determining the best methodology for creating clinically useful antibiograms for LTCFs needs to be explored. Possible approaches include (1) extending the isolate data beyond 1 year, (2) combining isolate data from the same geographic region, (3) using a nearby acute-care facility's antibiogram as a proxy, or (4) collapsing isolate data. This article discusses the benefits and limitations of each approach.


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