ArticleInfection control and hospital epidemiology2026
Optimizing facility-specific urinary weighted-incidence syndromic antibiograms for nursing homes.
Article in Infection control and hospital epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo develop an approach for creating facility-specific urinary antibiograms accounting for the low number of isolates recovered in nursing homes (NHs).
designRetrospective analysis of urine culture data collected in NHs in five states.
settingData on 5097 urine culture isolates collected across 59 study NHs from January 1, 2020 to December 31, 2021. Four consulting microbiology laboratories served the study homes.
methodsWe compared a Clinical and Laboratory Standards Institute (CLSI) standard antibiogram model to four weighted-incidence syndromic antibiogram (WISCA) models utilizing alternate formatting rules. Ability to produce a facility-specific antibiogram with at least 30 isolates and the impact on susceptibility predictions were compared.
resultsOnly one facility could generate a CLSI standard antibiogram for the three most commonly recovered Gram-negative isolates over a one-year period. Ability to generate an antibiogram increased with each of the four WISCA models trialed (36%, 54%, 85%, 85%) with the most successful models combining all Gram-negative isolates over a two-year period. Shortening the definition of duplicate isolates from 12 to 3 months did not improve performance. Using all Gram-negative isolates, rather than the three most recovered pathogens, resulted in meaningful changes in the predicted activity of ampicillin-sulbactam, cefazolin, ceftriaxone, and trimethoprim-sulfamethoxazole in several study NHs.
conclusionsThese results suggest that WISCAs using 2-years of urinary culture data including all gram-negative isolates and excluding duplicate isolates within twelve months maximizes the number of NHs able to create a valid antibiogram.
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