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New AST program to sharpen labs’ antibiotic stewardship practices

December 2020—Antimicrobial Susceptibility Testing: Monitoring and Trend Analysis is a new CAP program that is beginning to roll out to laboratories this month.

The CDC guidance for antibiotic stewardship consists of seven core elements to address resistance-associated risks, one of which points to the importance of laboratory collaboration, communication, and AST reporting practices to the success of stewardship programs. According to this core element, the laboratory must provide information to guide discussions on the potential implementation of test interpretive criteria, such as changes in antibiotic breakpoints, that might affect antibiotic use.

“Accredited laboratories that provide microbiology testing are already required to report a cumulative susceptibility report, an antibiogram, at least annually for antibiotic stewardship and to inform prescribing practices,” says Ron B. Schifman, MD, a member of the CAP Quality Practices Committee, which developed the program. Results from those antibiograms along with the antibiotic breakpoints used for testing are the primary data that laboratories enrolled in the new program will submit yearly, he says. “So participation in the program should require little extra effort.”

Since one of the program’s goals is to help laboratories track institutional trends in susceptibility rates over time, participants will also be instructed to submit data from two prior year antibiograms when they first enroll, says Dr. Schifman, emeritus professor of pathology, University of Arizona College of Medicine, and former chief of pathology, Southern Arizona VA Health Care System.

Dr. Schifman

The data that participants in the program submit will undergo robust statistical analysis, Dr. Schifman says, to identify significant changes in institutional susceptibility rates over time. The report labs receive will contain comparisons of the institution’s susceptibility results with those of other participants. “These reports will add a lot of extra information beyond the laboratory’s regular antibiogram summary that should be helpful to the institution and its stewardship program,” Dr. Schifman says.

The CAP program will also help labs with antibiogram reporting practices that might involve, for example, antibiotic breakpoint decisions, or with evaluating how a lab’s procedures for creating antibiograms align with reporting guidelines, primarily from the Clinical and Laboratory Standards Institute.