Why NPs Need to Antibiogramit!

Part of MidlevelU's residency-like program for NPs, which we fondly refer to as MMU, consists of weekly education sessions for newly minted nurse practitioners. I have the distinct pleasure of sitting in on these sessions, and learning from our weekly speakers. Although with eight years of experience, I am now comfortable in my practice, there's always more to learn. This past week, while listening to our speaker, I got a more in depth glance at the concept of an antibiogram and became convinced that implementing this tool into my practice would be a valuable move to make. 

As nurse practitioners, sometimes it feels like we're guessing when we treat our patients. We know that, for example, when we prescribe medication to treat a UTI, there is a chance we will be calling the patient back in a mere 48 hours to change their antibiotic based on the results of a urine culture. Not only does this create more work for us as providers, it also means our patients go for a period of time without taking the best medication to treat their illness. 

Most of us are aware of macro antibiotic resistance trends and consider this in prescribing decisions. We recognize that the Z-pack is losing the punch it once packed, and that gonorrhea is becoming increasingly more difficult to treat with go-to drugs. But, did you know that there are micro resistance patterns occurring within your local community and even your own healthcare facility? This is where the antibiogram comes in to play. 

What is an antibiogram?

An antibiogram is a "periodic summary of antimicrobial susceptibilities of local bacterial isolates". In other words, an antibiogram looks at the drugs various types of bacteria are susceptible to in a smaller, defined area. This may be a geographic area, such as a city or county. Or, this may be even more localized, and contain susceptibility data for a single hospital or hospital system. 

What does an antibiogram look like?

An antibiogram is essentially a spreadsheet outlining the latest data from your facility's or area's labs. It might look something along the lines of this example from the Minnesota Department of Health

Why should nurse practitioners use an antibiogram?

Given that antibiotic susceptibility varies on a local scale, knowledge of antibiotic resistance trends in your area or facility can help you as a nurse practitioner prescribe more effectively. The antibiogram provides the percentage of samples for a given organism which were sensitive to a specified antibiotic. So, nurse practitioners can select the antibiotic with the greatest chance of eliminating the bacteria at hand. In many cases, you may still need to culture a sample from the patient you are treating, but an antibiogram can help you get started by picking the best possible antibiotic as you await culture results. 

Where can you find your local antibiogram?

You may have to do a little searching to find your local antibiogram. If you work for a large health system or healthcare facility, your company's lab or pharmacy department should have access to the antibiogram for your institution. If you work for a smaller facility that does not perform such research internally, contact the lab company your facility outsources to as they may be collecting this data. Finally, you can also contact your local health department or do a quick internet search to locate the antibiogram for your area. 

Have you ever used an antibiogram in your practice?

 

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