While the use of cumulative susceptibility reports, antibiograms, is recommended for improved empiric therapy and antibiotic stewardship, the predictive ability of antibiograms has not been well-studied. While enhanced antibiograms have been shown to better capture variation in susceptibility profiles by characteristics such as infection site or patient age, the potential for seasonal or spatial variation in susceptibility has not been assessed as important in predicting likelihood of susceptibility. Utilizing Staphylococcus aureus isolates obtained in outpatient settings from a nationwide provider of care, the Veterans Health Administration, and a local provider of care, the University of Iowa Hospitals and Clinics, standard, seasonal and spatial antibiograms were created for five commonly used antibiotic classes: cephalosporins, clindamycin, macrolides, tetracycline, trimethoprim/sulfamethoxazole. A total of 338,681 S. aureus isolates obtained in VHA outpatient settings from 2010 to 2019 and 6,817 isolates obtained in UIHC outpatient settings from 2014 to 2019 were used to generate and test antibiograms. Logistic regression modeling determined the capacity of these antibiograms to predict isolate resistance to each antibiotic class. All models had low predictive capacity, with areas under the curve of < 0.7. Standard antibiograms are poor in predicting S. aureus susceptibility to antibiotics often chosen by clinicians, and seasonal and spatial antibiograms do not provide an improved tool in anticipating non-susceptibility. These findings suggest that further refinements to antibiograms may be necessary to improve their utility in informing choice of effective antibiotic therapy.

中文翻译：

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使用季节和空间抗菌谱评估门诊金黄色葡萄球菌分离株抗菌素耐药性预测能力的提高潜力

虽然建议使用累积药敏报告、抗菌谱来改善经验治疗和抗生素管理，但抗菌谱的预测能力尚未得到充分研究。虽然增强的抗菌谱已被证明可以更好地捕捉感染部位或患者年龄等特征引起的敏感性分布变化，但敏感性季节性或空间变化的潜力尚未被评估为预测敏感性可能性的重要因素。利用从全国医疗服务提供者、退伍军人健康管理局和当地医疗服务提供者、爱荷华大学医院和诊所获得的金黄色葡萄球菌分离株，为五种常用抗生素类别创建了标准、季节性和空间抗菌谱：头孢菌素类、克林霉素、大环内酯类、四环素、甲氧苄啶/磺胺甲恶唑。使用 2010 年至 2019 年在 VHA 门诊环境中获得的总共 338,681 个金​​黄色葡萄球菌分离株和 2014 年至 2019 年在 UIHC 门诊环境中获得的 6,817 个金黄色葡萄球菌分离株来生成和测试抗菌谱。逻辑回归模型确定了这些抗生素图谱预测菌株对每种抗生素类别的耐药性的能力。所有模型的预测能力都很低，曲线下面积 < 0.7。标准抗菌谱在预测金黄色葡萄球菌对临床医生经常选择的抗生素的敏感性方面效果不佳，并且季节性和空间抗菌谱不能提供预测不敏感性的改进工具。这些发现表明，可能需要进一步完善抗菌谱，以提高其在选择有效抗生素治疗方面的效用。