Description and validation of a spectrum score method to measure antimicrobial de-escalation in healthcare associated pneumonia from electronic medical records data

Madaras-Kelly, Karl; Jones, Makoto; Remington, Richard; Caplinger, Christina; Huttner, Benedikt; Samore, Matthew

doi:10.1186/s12879-015-0933-9

Table 3 Ordinal susceptibility scores for antimicrobial-organism pairs included in the spectrum score

From: Description and validation of a spectrum score method to measure antimicrobial de-escalation in healthcare associated pneumonia from electronic medical records data

	Anti-MRSA*					βL- Inhibitors**			Carbapenems & aztreonam***			Cephalosporins****
	Vanc	Lzld	Tig	Dapto	Ceftar	Pip/Taz	Tic/Clav	Amino-BLI	PSA Carb	Erta	Aztr	1st Gen Ceph	2nd Gen Ceph	3rd Gen Ceph	PSA Ceph
Gram positive organisms
Staphylococcus aureus	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4κ	2¥	2¥	2¥	2¥	2¥	0I	2¥	2¥	2¥	2¥
Streptococcus pneumoniae	4Ϯ	4Ϯ	4κ	0Ψ	4κ	3¥	3¥	3¥	4Ϯ	4Ϯ	0I	3Ϯ	3Ϯ	4Ϯ	4Ϯ
Enterococcus faecalis	4Ϯ	4Ϯ	4Ϯ	4Ϯ	0¥	4Ϯ	4κ	4Ϯ	4Ϯ	0κ	0I	0¥	0¥	0¥	0¥
Enterococcus faecium	4Ϯ	4Ϯ	4Ϯ	4Ϯ	0¥	1Ϯ	1κ	1Ϯ	0Ϯ	0κ	0I	0¥	0¥	0¥	0¥
Gram negative organisms
Escherichia coli	0I	0I	4Ϯ	0I	4κ	4Ϯ	4Ϯ	3Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ
Klebsiella spp.	0I	0I	4Ϯ	0I	4κ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ
OtherEnterobacteriaceae	0I	0I	3Ϯ	0I	3κ	4Ϯ	4Ϯ	2Ϯ	4Ϯ	4Ϯ	4Ϯ	1Ϯ	2Ϯ	4Ϯ	4Ϯ
Enterobacter spp.	0I	0I	4Ϯ	0I	3κ	4Ϯ	3Ϯ	0Ϯ	4Ϯ	4Ϯ	4Ϯ	0Ϯ	1Ϯ	4Ϯ	4Ϯ
Citrobacter spp.	0I	0I	4Ϯ	0I	4κ	4Ϯ	4Ϯ	3Ϯ	4Ϯ	4Ϯ	4Ϯ	2Ϯ	3Ϯ	4Ϯ	4Ϯ
Serratia spp.	0I	0I	4Ϯ	0I	3κ	4Ϯ	4Ϯ	0Ϯ	4Ϯ	4Ϯ	4Ϯ	0Ϯ	0Ϯ	4Ϯ	4Ϯ
Morganella spp.	0I	0I	2Ϯ	0I	3κ	4Ϯ	3Ϯ	0Ϯ	4Ϯ	4Ϯ	4Ϯ	0Ϯ	0Ϯ	4Ϯ	4Ϯ
Proteus spp.	0I	0I	1Ϯ	0I	4κ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ	4Ϯ
Providencia spp.	0I	0I	2Ϯ	0I	0Ψ	4Ϯ	4Ϯ	0	4Ϯ	4Ϯ	4Ϯ	0Ϯ	2Ϯ	4Ϯ	4Ϯ
Pseudomonas aeruginosa	0I	0I	0I	0I	0I	4Ϯ	4Ϯ	0I	4Ϯ	1Ϯ	4Ϯ	0I	0I	0Ϯ	4Ϯ
Acinetobacter spp.	0I	0I	4Ϯ	0I	0κ	3Ϯ	3Ϯ	3Ϯ	3Ϯ	0κ	0Ϯ	0Ψ	0Ψ	1Ϯ	3Ϯ
Stenotrophomonas spp.	0I	0I	3Ϯ	0I	0κ	3Ϯ	2Ϯ	0I	0Ϯ	0κ	0Ϯ	0Ψ	0Ψ	0Ϯ	1Ϯ
Haemophilus influenzae	0I	0κ	4κ	0I	4κ	4¥	4Ψ	4Ϯ	4Ϯ	4κ	4κ	3Ψ	4Ϯ	4Ϯ	4Ϯ
Bacteroides spp.	0I	0κ	4κ	0I	0I	4Ϯ	3Ω	4Ϯ	4Ϯ	4¥	0I	0I	0I	1Ϯ	0I
Other organisms
Atypical organisms	0I	0κ	4κ	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I
Legionella spp.	0I	0κ	4κ	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I
Mycoplasma spp.	0I	0κ	4κ	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I	0I
	Penicillins*****		Miscellaneous******
	Amino PCN	Semi Synth PCN	PSAFQ	NON-PSAFQ	Amik	Gent or Tobra	Macro	Clinda	Tetra	TMP/SMX	Metro	Colistin
Gram positive organisms
Staphylococcus aureus	0Ϯ	2Ϯ	2Ϯ	3Ϯ	4Ϯ	4Ϯ	1Ϯ	3Ϯ	4Ϯ	4Ϯ	0I	0κ
Streptococcus pneumoniae	3Ϯ	3¥	4Ϯ	4Ϯ	0κ	0κ	3Ϯ	4Ϯ	3Ϯ	3Ϯ	0I	0κ
Enterococcus faecalis	4Ϯ	0κ	3Ϯ	3Ϯ	0I	0I	0Ϯ	0¥	1Ϯ	0¥	0I	0κ
Enterococcus faecium	0Ϯ	0κ	0Ϯ	0Ϯ	0I	0I	0Ϯ	0¥	1Ϯ	0¥	0I	0κ
Gram negative organisms
Escherichia coli	2Ϯ	0I	3Ϯ	3Ϯ	4Ϯ	4Ϯ	0I	0I	3Ϯ	3Ϯ	0I	4Ϯ
Klebsiella spp.	0Ϯ	0I	4Ϯ	4Ϯ	4Ϯ	4Ϯ	0I	0I	4Ϯ	4Ϯ	0I	4Ϯ
OtherEnterobacteriaceae	1Ϯ	0I	3Ϯ	3Ϯ	4Ϯ	4Ϯ	0I	0I	2Ϯ	4Ϯ	0I	2Ϯ
Enterobacter spp.	0Ϯ	0I	4Ϯ	4Ϯ	4Ϯ	4Ϯ	0I	0I	4Ϯ	4Ϯ	0I	4Ϯ
Citrobacter spp.	0Ϯ	0I	4Ϯ	4Ϯ	4Ϯ	4Ϯ	0I	0I	4Ϯ	4Ϯ	0I	4Ϯ
Serratia spp.	0Ϯ	0I	4Ϯ	4Ϯ	4Ϯ	4Ϯ	0I	0I	0Ϯ	4Ϯ	0I	3Ϯ
Morganella spp.	0Ϯ	0I	3Ϯ	2Ϯ	4Ϯ	4Ϯ	0I	0I	1Ϯ	3Ϯ	0I	1Ϯ
Proteus spp.	3Ϯ	0I	3Ϯ	3Ϯ	4Ϯ	4Ϯ	0I	0I	0Ϯ	3Ϯ	0I	0κ
Providencia spp.	0Ϯ	0I	2Ϯ	2Ϯ	4Ϯ	2Ϯ	0I	0I	0Ϯ	3Ϯ	0I	0Ψ
Pseudomonas aeruginosa	0I	0I	3Ϯ	1Ϯ	4Ϯ	4Ϯ	0I	0I	0I	0I	0I	4Ϯ
Acinetobacter spp.	0Ϯ	0I	3Ϯ	2Ϯ	4Ϯ	3Ϯ	0I	0I	2Ϯ	3Ϯ	0I	4Ϯ
Stenotrophomonas spp.	0Ϯ	0I	4Ϯ	2Ϯ	2Ϯ	1Ϯ	0I	0I	3Ϯ	4Ϯ	0I	4Ϯ
Haemophilus influenzae	3¥	0I	4Ϯ	4Ϯ	4κ	4κ	4Ϯ	0Ψ	4Ϯ	3Ϯ	0I	4κ
Bacteroides spp.	0Ϯ	0I	2κ	2¥	0I	0I	0κ	3Ϯ	1κ	0κ	4Ϯ	0I
Other organisms
Atypical organisms	0I	0I	4κ	4κ	2κ	2κ	4κ	0κ	4κ	2κ	0I	0I
Legionella spp.	0I	0I	4κ	4κ	4κ	0κ	4κ	0κ	4κ	4κ	0I	0I
Mycoplasma spp.	0I	0I	4κ	4κ	0Ψ	0Ψ	4κ	0κ	4κ	0κ	0I	0I

Special Notations:
Ϯ VA susceptibility data.
I No intrinsic activity.
Ψ Investigator opinion.
Ω Limited VA susceptibility data.
¥ Expert rule.
Κ Literature based.
Abbreviations:
*Anti-MRSA: Vanc = vancomycin; Lzld = linezolid; Tig = tigecycline; Dapto = daptomycin, Ceftar = ceftaroline.
**βL- Inhibitors: Pip/Taz = piperacillin/tazobactam; Tic/Clav = ticarcillin/clavulanate; AminoBLI = ampicillin/sulbactam, amoxicillin/clavulanate.
***Carbapenems and Aztreonam: PSACarba = imipenem, meropenem, Erta = ertapenem, Aztr = aztreonam.
****Cephalosporins: 1st Gen Ceph. = cefazolin, cephalexin; 2nd Gen Ceph = cefuroxime; 3rd Gen Ceph = ceftriaxone, cefotaxime, cefpodoxime; PSACeph = cefepime, ceftazidime.
*****Penicllins: AminoPCN = ampicillin, amoxicillin, penicillin; SemiSynthPCN = oxacillin, nafcillin.
******Miscellaneous: PSAFQ = ciprofloxacin or levofloxacin; NONPSAFQ = moxifloxacin, gemifloxacin; Amik = Amikacin; Gent or Tobra = gentamicin, tobramycin; Macro = erythromycin, azithromycin, clarithromycin; Clinda = clindamycin; Tetra = tetracycline, doxycycline; TMP/SMX = trimethoprim/sulfamethoxazole; Metro = metronidazole; Colistin = colistin.

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