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Multicenter Study
. 2023 Nov 30;77(11):1492-1500.
doi: 10.1093/cid/ciad467.

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  1   2 , Daniel J Livorsi  1   2 , Eli N Perencevich  1   2 , Jonas N Church  2 , Michihiko Goto  1   2
Affiliations
Multicenter Study

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 et al. Clin Infect Dis. .

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 Escherichia 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.

Keywords: antimicrobial resistance; diagnostic accuracy; empiric therapy; gram-negative rods; hospital antibiogram.

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Conflict of interest statement

Potential conflicts of interest. M. G. and D. L. report grants or contracts from Merck Investigator Study Program (paid to institution). D. L. also reports grants or contracts from Centers and Disease Control and Prevention (CDC) Epicenter Grant (grant number J207400-G) (Herwaldt) and VA Health Services Research and Development Service (HSR&D) Investigator Initiated Research (IIR) (grant number 20–280); support for attending meetings and/or travel as a Speaker at SHEA Spring 2023. M. G. also reports the CDC Epicenter Grant (grant number J207400-G) (Herwaldt). E. N. P. reports grants or contracts paid to institution from VA-CDC Practice-Based Research Network program and VA HSR&D (grant numbers CIN 13-412 and QUE 15-269). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
The creation process of standardized antibiograms and a patient-level data set.
Figure 2.
Figure 2.
ROC curves of antibiograms to predict non-susceptibility for 3 major antimicrobial groups. Abbreviations: AUC, area under the curve; ROC, receiver operating characteristic.
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