Knowledge and Use of Cumulative Antimicrobial Susceptibility Data at a University Teaching Hospital

To the Editor—We devised and performed a voluntary, anonymous online survey of the 545 residents and fellows in our housestaff training programs in 2007 to determine whether they were aware of cumulative antimicrobial susceptibility data on our hospital intranet and if this or similar data was used in clinical decision making. Three hundred twenty-six (60%) of 545 house officers completed the survey; 59% were in postgraduate year 1–3, the remainder were in postgraduate year 4–8. The primary patient population cared for by the house officers who responded was adult (54%), pediatric (17%), or both (29%). The largest programs represented were internal medicine (42%), surgery (15%), and pediatrics (14%). Although 74% of house officers responded that they had used general antimicrobial susceptibility data provided in the Sanford Guide, 0%, 3%, 33%, and 64% responded that they always, frequently, occasionally, or never used our hospital's cumulative (not patient-specific) antimicrobial susceptibility data, respectively. Of those who responded that they occasionally or never used the hospital data, 61% responded that they did not know where to find it, and 14% found it inconvenient to access. When asked if they would use unit-specific antimicrobial susceptibility data (i.e., specified by microorganism and hospital ward) when prescribing antibiotics, 71%, 26%, and 3% responded yes, possibly, or no, respectively. House officers are frequent prescribers of antimicrobial agents, and our survey suggests that they use antimicrobial susceptibility data in decision making. However, at our institution, they use generalized information, which is most easily accessible to them (i.e., the Sanford Guide), rather than hospital-specific data, which are less accessible. The Centers for Disease Control's 12-Step Program to Prevent Antimicrobial Resistance Among Hospitalized Patients suggests that health care providers use local antibiotic susceptibility data when choosing empirical therapy [1]. The Joint Commission on the Accreditation of Healthcare Organizations recognizes the importance of such data as a quality assurance measure [2]. Nevertheless, the potential impact of local antimicrobial susceptibility data will be constrained unless the information is easily accessible to antibiotic prescribers. Surveys have found variability in analysis and presentation of antimicrobial susceptibility data [3, 4], and recent consensus guidelines have addressed this issue [5]. On the basis of our survey, more attention is needed in health care delivery settings to easily and expeditiously communicate this important information to end users as an integral component of a successful antibiotic stewardship program [6]. Financial support. Financial support for this survey was from a Risk Management Grant Award from Lifespan Risk Services. Potential conflicts of interest. All authors: no conflicts.