177. User Preferences for Visualization of Antibiogram Data in Clinical Practice for Empiric Prescription of Antibiotics

Abstract Background Antibiograms are widely used to present antibiotic susceptibility data, but user preferences for data visualization have received little attention. We report on a qualitative research study designed to gauge preferences for presenting antibiotic resistance data, with the goals of improving speed and effectiveness of prescribing empiric antibiotics in out-patient practices to meaningfully influence antibiotic stewardship programs. Methods Criteria for online focus groups included having the ability to prescribe antibiotics, practice in Washington state, and familiarity with antibiogram usage. A preliminary survey (Fig. 1) was sent to selected participants to understand their role in healthcare and their current attitudes towards antibiograms. During focus groups, we presented examples of 3 antibiograms: standard (Fig. 2A), color-coded for % susceptible (Fig. 2B), and color-coded for change in % susceptible from 2013 to 2016 (Fig. 2C). Figure 1. Preliminary Survey via RedCap A preliminary survey via RedCap was sent all focus group participants to capture current attitudes towards antibiograms and antibiotic resistance data. Figure 2. Presented antibiograms for focus group discussions using Quest Data. (A) Standard antibiogram for displaying % susceptibility. (B) Antibiogram color-coded for % susceptibility. (C) Antibiogram color-coded for change in % susceptibility, comparing 2013 data to 2016 data. Results Focus groups were held between October 2020 and March 2021. Participants were 44 years of age on average, with 6-23 years of experience in primary care and/or infectious disease practice. Eight of nine participants took the preliminary survey. The survey revealed that 5 (63%) participants used antibiograms in their practice. Most participants (7; 88%) preferred an online format to print out antibiogram tables. Discourse analysis from focus groups (n=3) revealed common themes regarding Figures 2A-C as examples of antibiograms. Key ideas included discussion of the data source and content, arrangement of the table, usability during clinical days, and efforts for antibiotic stewardship related to antibiogram use. All focus group participants (n=9) favored the feature of color-coding cells and found the data in the Fig. 2B user friendly. Consensus across all groups was that antibiogram tables would not be useful for daily practice. Clinicians would rather receive simplified therapy suggestions either in the patient laboratory report or in the electronic health system. Conclusion Antibiograms can be useful for visualization of empirical data but can become a more useful tool if they can be interpreted and simplified for guiding empiric prescribing in daily out-patient practice. Disclosures Hema Kapoor, MD; D(ABMM), Quest Diagnostics (Employee, I am an employee of Quest Diagnostics and receive its stock as part of my employment.) Ann Salm, M (ASCP), MSc, PhD, Quest Diagnostics (Employee, I am an employee of Quest Diagnostics and receive its stock as part of my employment.)

Background. Data suggest that topical antibiotic and antiseptic use in the operating room is common but not commonly monitored by antimicrobial stewardship programs. Although some data suggest a benefit in certain surgical procedures, the CDC and WHO advise against the routine use of topical antibiotics in surgery due to uncertainty and heterogeneity in the overall data.
Methods. We conducted a retrospective 28-day period prevalence study of topical antibiotic and antiseptic use during surgical procedures performed in the operating room by 6 surgical specialties at a tertiary care medical center. For the subset of patients undergoing orthopedic surgeries, we evaluated the types of topical antibiotics received and the rates of surgical site infections (SSI) and adverse drug events within 28 days of the procedure.
Results. Of 744 surgical procedures reviewed, topical antibiotics were used in 127 (17.1%), topical antiseptics in 71 (9.5%), and both in 18 (2.4%) ( Table 1). Antiseptic use was higher in orthopedics relative to all other surgical specialties while topical antibiotic use was higher in neurosurgery. Hand, vascular and plastics had distinguishably lower use. In the orthopedic subgroup, after exclusions, 218 procedures were evaluated. Topical antibiotics were used in 42 (19.2%). Topical antibiotic therapy was more likely to be administered if prosthetic material was implanted, the procedure was emergent, or if a Staphylococcus aureus infection was present. Vancomycin was the most commonly used topical antibiotic and powder was the most commonly used type of application. As shown in table 2, SSI occurred more often when both topical antibiotics and antiseptics were applied; however, SSI events were relatively uncommon, and these were more likely to have infection present at the time of surgery. Adverse events were rare.

Conclusion.
In our institution we noted significant variability in use of topical antibiotic and antiseptic therapy among surgical specialties as well as within the orthopedic surgical specialty. Although opportunities to standardize use/nonuse of these therapies exist, this may be challenging due to the uncertainty and heterogeneity of currently available data. Background. Antibiograms are widely used to present antibiotic susceptibility data, but user preferences for data visualization have received little attention. We report on a qualitative research study designed to gauge preferences for presenting antibiotic resistance data, with the goals of improving speed and effectiveness of prescribing empiric antibiotics in out-patient practices to meaningfully influence antibiotic stewardship programs.

User Preferences for Visualization of Antibiogram Data in Clinical Practice for Empiric Prescription of Antibiotics
Methods. Criteria for online focus groups included having the ability to prescribe antibiotics, practice in Washington state, and familiarity with antibiogram usage. A preliminary survey ( Fig. 1) was sent to selected participants to understand their role in healthcare and their current attitudes towards antibiograms. During focus groups, we presented examples of 3 antibiograms: standard ( Fig. 2A), color-coded for % susceptible (Fig. 2B), and color-coded for change in % susceptible from 2013 to 2016 (Fig. 2C).

Figure 1. Preliminary Survey via RedCap
A preliminary survey via RedCap was sent all focus group participants to capture current attitudes towards antibiograms and antibiotic resistance data.