The Utility, Development and Interpretation of Antibiograms: A Review On Their Role in Empirical Antibacterial Selection Amidst Escalating Antimicrobial Resistance
DOI:
https://doi.org/10.52783/jns.v14.2548Keywords:
antimicrobial resistance, CLSI M39 guidelines, precision antibiograms, resistance mapping, empirical therapyAbstract
With the global rise of antimicrobial resistance, antimicrobial stewardship efforts have been on the rise significantly. Antibiograms have become vital tools in enabling clinical decision making, guiding empirical therapy and mapping epidemiological resistance patterns. The antibiograms have now developed from the traditional antibiogram to the rolling antibiograms that changes with time to the electronic versions of the tool. Additionally, antibiograms are now bridging the gap in precision medicine with personalized antibiograms and machine learning approaches. In this review, we understand from existing literature that although antibiogram is being widely used, adherence to the standard guidelines is relatively lower in rates. Standardising antibiograms by sticking to the CLSI consensus M39 guidelines can be constitutive in making antibiograms more versatile. It has also been identified that many physicians are not used to utilizing antibiograms in their day-to-day practice. As resistance tracking tools, antibiotics can help understand local patterns of resistance in a community that can help public health policies or clinical choices. Enhancing ease of use and continuum education on their utility as part of Antimicrobial Stewardship programmes is fundamental in bridging this gap.
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Naimi T, Ringwald P, Besser R, Thompson S. Antimicrobial resistance. Emerg Infect Dis [Internet]. 2001 [cited 2024 Nov 12];7:548–548. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet [Internet]. 2024;404(10459):1199–226. Available from: http://dx.doi.org/10.1016/S0140-6736(24)01867-1
Dadgostar P. Antimicrobial resistance: Implications and costs. Infect Drug Resist [Internet]. 2019;12:3903–10. Available from: http://dx.doi.org/10.2147/idr.s234610
Ayukekbong, J. A., Ntemgwa, M., & Atabe, A. N. (2017). The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrobial Resistance and Infection Control, 6(1). https://doi.org/10.1186/s13756-017-0208-x
Silbergeld EK, Graham J, Price LB. Industrial food animal production, antimicrobial resistance, and human health. Annu Rev Public Health [Internet]. 2008;29(1):151–69. Available from: http://dx.doi.org/10.1146/annurev.publhealth.29.020907.090904
Endale H, Mathewos M, Abdeta D. Potential causes of spread of antimicrobial resistance and preventive measures in one health perspective-A review. Infect Drug Resist [Internet]. 2023;16:7515–45. Available from: http://dx.doi.org/10.2147/IDR.S428837
Bantar C, Alcazar G, Franco D, Salamone F, Vesco E, Stieben T, et al. Are laboratory-based antibiograms reliable to guide the selection of empirical antimicrobial treatment in patients with hospital-acquired infections? Journal of Antimicrobial Chemotherapy. 2006 Oct 28;59(1):140–3.
Truong WR, Hidayat L, Bolaris MA, Nguyen L, Yamaki J. The antibiogram: key considerations for its development and utilization. JAC Antimicrob Resist [Internet]. 2021;3(2). Available from: http://dx.doi.org/10.1093/jacamr/dlab060
Fluit AC, Visser MR, Schmitz F-J. Molecular detection of antimicrobial resistance. Clin Microbiol Rev [Internet]. 2001;14(4):836–71. Available from: http://dx.doi.org/10.1128/cmr.14.4.836-871.2001
Pendleton JN, Gorman SP, Gilmore BF. Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther [Internet]. 2013;11(3):297–308. Available from: http://dx.doi.org/10.1586/eri.13.12
Binkley S, Fishman NO, LaRosa LA, et al. Comparison of Unit-Specific and Hospital-Wide Antibiograms Potential Implications for Selection of Empirical Antimicrobial Therapy. Infection Control & Hospital Epidemiology. 2006;27(7):682-687. doi:10.1086/505921
Pogue JM, Alaniz C, Carver PL, Pleva M, Newton D, DePestel DD. Role of unit-specific combination antibiograms for improving the selection of appropriate empiric therapy for gram-negative pneumonia. Infect Control Hosp Epidemiol [Internet]. 2011;32(3):289–92. Available from: http://dx.doi.org/10.1086/658665
Puzniak L, DePestel DD, Srinivasan A, Ye G, Murray J, Merchant S, et al. A combination antibiogram evaluation for Pseudomonas aeruginosa in respiratory and blood sources from intensive care unit (ICU) and non-ICU settings in U.S. hospitals. Antimicrob Agents Chemother [Internet]. 2019;63(4). Available from: http://dx.doi.org/10.1128/aac.02564-18
Hsu, A. J., Carroll, K. C., Milstone, A. M., Avdic, E., Cosgrove, S. E., Vilasoa, M., & Tamma, P. D. (2015). The Use of a Combination Antibiogram to Assist with the Selection of Appropriate Antimicrobial Therapy for Carbapenemase-Producing Enterobacteriaceae Infections. Infection control and hospital epidemiology, 36(12), 1458–1460. https://doi.org/10.1017/ice.2015.196
Lamoth F, Wenger A, Prod ‘Hom G, Vallet Y, Plüss-Suard C, Bille J, et al. Comparison of hospital-wide and unit-specific cumulative antibiograms in hospital- and community-acquired infection. Infection [Internet]. 2010;38(4):249–53. Available from: http://dx.doi.org/10.1007/s15010-010-0033-0
16. Pallavi Singh, M.Manisha, S.P.Muralidharan,et al. The assessment of insomnia and fatigue in night shift workers https://doi.org/10.37896/HTL27.5/3529
Kuster SP, Ruef C, Zbinden R, Gottschalk J, Ledergerber B, Neuber L, et al. Stratification of cumulative antibiograms in hospitals for hospital unit, specimen type, isolate sequence and duration of hospital stay. J Antimicrob Chemother [Internet]. 2008;62(6):1451–61. Available from: http://dx.doi.org/10.1093/jac/dkn384
Al-Dahir S, Gillard C, Brakta F, Figueroa JE. Antimicrobial susceptibilities of respiratory pathogens in the surgical/trauma intensive care unit compared with the hospital-wide respiratory antibiogram in a level I trauma centre. Surg Infect (Larchmt) [Internet]. 2015;16(1):62–7. Available from: http://dx.doi.org/10.1089/sur.2013.171
Corbin CK, Sung L, Chattopadhyay A, Noshad M, Chang A, Deresinksi S, et al. Personalized antibiograms for machine learning driven antibiotic selection. Commun Med (Lond) [Internet]. 2022;2(1):38. Available from: http://dx.doi.org/10.1038/s43856-022-00094-8
Klinker KP, Hidayat LK, DeRyke CA, DePestel DD, Motyl M, Bauer KA. Antimicrobial stewardship and antibiograms: importance of moving beyond traditional antibiograms. Ther Adv Infect Dis [Internet]. 2021;8:20499361211011373. Available from: http://dx.doi.org/10.1177/20499361211011373
Simpao AF, Ahumada LM, Larru Martinez B, Cardenas AM, Metjian TA, Sullivan KV, et al. Design and Implementation of a Visual Analytics Electronic Antibiogram within an Electronic Health Record System at a Tertiary Pediatric Hospital. Applied Clinical Informatics [Internet]. 2018 Jan 1;9(1):37–45. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801883/
Kaur A, Gill AK, Singh S et al. Prevalence and antibiogram of acinetobacter spp. isolated from various clinical samples in a tertiary care hospital, Bathinda. Int J Health Sci Res. 2016; 6(6):83-89.
Pallavi Singh , a review on drug utilization study of hypertensive drugs in outpatient in the department of general medicine of tertiary care hospital. https://www.pnrjournal.com/index.php/home/article/view/8648
Teitelbaum D, Elligsen M, Katz K, Lam PW, Lo J, MacFadden D, et al. Introducing the escalation antibiogram: A simple tool to inform changes in empiric antimicrobials in the nonresponding patient. Clin Infect Dis [Internet]. 2022;75(10):1763–71. Available from: http://dx.doi.org/10.1093/cid/ciac256
Qiu W, Nagl S. Automated Miniaturized Digital Microfluidic Antimicrobial Susceptibility Test Using a Chip-Integrated Optical Oxygen Sensor. ACS Sensors. 2021 Mar 15;6(3):1147–56.
Lacy MK, Klutman NE, Horvat RT, Zapantis A. Antibiograms: New NCCLS Guidelines, Development, and Clinical Application. Hospital Pharmacy. 2004 Jun;39(6):542–53.
Xu R, Polk RE, Stencel L, Lowe DK, Guharoy R, Duggal RW, et al. Antibiogram compliance in University HealthSystem Consortium participating hospitals with Clinical and Laboratory Standards Institute guidelines. American Journal of Health-System Pharmacy. 2012 Apr 1;69(7):598–606.
Moehring RW, Hazen KC, Hawkins MR, Drew RH, Sexton DJ, Anderson DJ. Challenges in Preparation of Cumulative Antibiogram Reports for Community Hospitals. Journal of Clinical Microbiology [Internet]. 2015 Sep 1 [cited 2021 Jun 15];53(9):2977–82. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540907/
Simner PJ, Hindler JA, Bhowmick T, Das S, Johnson JK, Lubers BV, et al. What’s New in Antibiograms? Updating CLSI M39 Guidance with Current Trends. Humphries RM, editor. Journal of Clinical Microbiology. 2022 Oct 19;60(10).
Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100, 31st Edition. Journal of Clinical Microbiology. 2021 Sep 22;
Chung JW. Introduction to the Revised International Guidelines on Breakpoints for Antimicrobial Susceptibility Testing. Annals of Clinical Microbiology. 2023 Sep 20;26(3):51–7.
Pierce VM, Mathers AJ. Setting Antimicrobial Susceptibility Testing breakpoints: A primer for pediatric infectious diseases specialists on the clinical and Laboratory Standards Institute approach. J Pediatric Infect Dis Soc [Internet]. 2022;11(2):73–80. Available from: http://dx.doi.org/10.1093/jpids/piab106
Ursula Waack, Abhay Joshi, Seong H Jang, Kellie S Reynolds, Variations in pharmacokinetic-pharmacodynamic target values across MICs and their potential impact on determination of susceptibility test interpretive criteria, Journal of Antimicrobial Chemotherapy, Volume 76, Issue 11, November 2021, Pages 2884–2889, https://doi.org/10.1093/jac/dkab282
Mouton JW, Brown DFJ, Apfalter P, Cantón R, Giske CG, Ivanova M, et al. The role of pharmacokinetics/pharmacodynamics in setting clinical MIC breakpoints: the EUCAST approach. Clin Microbiol Infect [Internet]. 2012;18(3):E37-45. Available from: http://dx.doi.org/10.1111/j.1469-0691.2011.03752.x
Ferraro MJ, Wikler MA, Jorgensen JH. FDA and the antibiotic breakpoint updating process. Microbe Wash DC [Internet]. 2007;2(7):321–2. Available from: http://dx.doi.org/10.1128/microbe.2.321.3
Tulkens PM. Towards Rational International Antibiotic Breakpoints: Actions from the European Committee on Antimicrobial Susceptibility Testing (EUCAST). International Journal of Antimicrobial Agents. 2005 Jan 1;26.
Gaur P, Hada V, Rath RS, Mohanty A, Singh P, Rukadikar A. Interpretation of Antimicrobial Susceptibility Testing using European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI) breakpoints: Analysis of agreement. Cureus [Internet]. 2023;15(3):e36977. Available from: http://dx.doi.org/10.7759/cureus.36977
Suravaram S, Hada V, Ahmed Siddiqui I. Comparison of antimicrobial susceptibility interpretation among Enterobacteriaceae using CLSI and EUCAST breakpoints. Indian J Med Microbiol [Internet]. 2021;39(3):315–9. Available from: http://dx.doi.org/10.1016/j.ijmmb.2021.05.004
Kassim, A., Omuse, G., Premji, Z. et al. Comparison of Clinical Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines for the interpretation of antibiotic susceptibility at a university teaching hospital in Nairobi, Kenya: a cross-sectional study. Ann Clin Microbiol Antimicrob 15, 21 (2016). https://doi.org/10.1186/s12941-016-0135-3
Pfaller MA, Diekema DJ, Andes D, Arendrup MC, Brown SD, Lockhart SR, et al. Clinical breakpoints for the echinocandins and Candida revisited: Integration of molecular, clinical, and microbiological data to arrive at species-specific interpretive criteria. Drug Resistance Updates. 2011 Jun;14(3):164–76.
Palmeira JD, Ferreira H. CLSI - EUCAST: Comparison of antibiotic-susceptibility profile of Enterobacteriaceae of animal origin according to the standards. Acta Microbiol Immunol Hung [Internet]. 2019;66(4):413–22. Available from: http://dx.doi.org/10.1556/030.66.2019.037
Yamano Y, Takemura M, Longshaw C, Echols R. 1269. Differences in interpretative breakpoints between CLSI, FDA and EUCAST impact reporting of susceptibility and resistance to cefiderocol. Open Forum Infect Dis [Internet]. 2020;7(Supplement_1):S651–S651. Available from: http://dx.doi.org/10.1093/ofid/ofaa439.1453
Thomas P Lodise, Sujata M Bhavnani, Paul G Ambrose, Helio S Sader, David Andes, Jason M Pogue, on behalf of the US Committee on Antimicrobial Susceptibility Testing, Piperacillin/Tazobactam Susceptibility Test Interpretive Criteria for Enterobacterales: Recommendations from the United States Committee on Antimicrobial Susceptibility Testing, Clinical Infectious Diseases, 2024; ciae328, https://doi.org/10.1093/cid/ciae328
Furuno JP, Comer AC, Johnson JK, Rosenberg JH, Moore SL, MacKenzie TD, et al. Using antibiograms to improve antibiotic prescribing in skilled nursing facilities. Infect Control Hosp Epidemiol [Internet]. 2014;35 Suppl 3(S3):S56-61. Available from: http://dx.doi.org/10.1086/677818
Cooper SJ, Destache CJ, Vivekanandan R. Improving understanding and utilization of the antibiogram among medical residents. Antimicrob Steward Healthc Epidemiol [Internet]. 2022;2(1):e142. Available from: http://dx.doi.org/10.1017/ash.2022.275 Krishnamoorthy SG, Raj V, Viswanathan B, Dhanasekaran GP, Palaniappan D, Borra SS. Enhancing the empiric antibiotic selection by introducing an antibiogram toolkit in a tertiary care hospital in Southern India – A prospective study. J Clin Pharm Ther [Internet]. 2022;47(4):507–16. Available from: http://dx.doi.org/10.1111/jcpt.13571
DIKKATWAR MS, Mansuri F, Chaudhari M, Marathe A, Vaghasiya J, Nath M. Development of Antibiogram for Evaluation of Antibiotic Resistance Pattern in Tertiary Care Teaching Hospital: A Cross-Sectional Study.
Tallman GB, Vilches-Tran RA, Elman MR, Bearden DT, Taylor JE, Gorman PN, et al. Empiric Antibiotic Prescribing Decisions Among Medical Residents: The Role of the Antibiogram. Infection Control & Hospital Epidemiology. 2018;39(5):578–83. doi:10.1017/ice.2018.28
Munita JM, Arias CA. Mechanisms of Antibiotic Resistance. Virulence Mechanisms of Bacterial Pathogens. 2016 Apr 9;481–511.
Singh P, Geetha P. Antidepressants exposure during gestation and their impact on the neurodevelopment and physical outcomes in the off spring. Int J Health Sci (IJHS) [Internet]. 2022 [cited 2025 Mar 21];6(S3):5656–64. Available from: https://sciencescholar.us/journal/index.php/ijhs/article/view/7209
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