Optimizing Antimicrobial Susceptibility Test Reporting

A meeting of clinical microbiologists, representing a diverse group of practice settings, together with representatives from industry partners, discussed the pitfalls of current practices for testing and reporting antimicrobial susceptibility test results. The participants in this session identified several needs. Regarding what antibiotics to test, the discussants noted that the CLSI M100 documents must be readily accessible to all those who need them and presented in a way that is easily understood. Engineering controls (e.g., software programs) are needed that incorporate intrinsic resistance and susceptibility information and contain pathways that would allow the reporting of antibiotics for only those body locations where the antibiotic reaches therapeutic concentrations. These programs should be linked with the patient electronic medical record (EMR) and flag the physician or clinical pharmacist using an active alert messenger when testing reveals that the antibiotic(s) that the patient is receiving may not be optimal or de-escalation of the antibiotic treatment regimen is indicated. Guidelines for the practice of cascade reporting are needed and should be developed to assist laboratories in the identification and reporting of therapeutic and cost-effective antimicrobials. Personalized antibiotic reporting (PAR) software programs are needed that would deduce the optimal antibiotic for each individual patient based on a number of clinical and laboratory features. These would include the following: (i) organism identification; (ii) MIC; (iii) patient-specific factors such as weight, immune status, allergies, creatinine clearance, and albumin level; (iv) site of infection; (v) desired method of dosing (bolus versus continuous infusion); (vi) patient convenience (oral versus intravenous); (vii) drug interactions; and (viii) cost.