Name of Nursing Home/Name of Laboratory

Comprehensive Antibiogram Toolkit: Phase 3 - Sample Pocket Card Short Version (Use Avery #5302 tent cards)

Antibiogram for MM/DD/YY to MM/DD/YY

[Name of Nursing Home/Name of Laboratory]

Gram Negative
Escherichia coli / Klebsiella pneumoniae / Proteus mirabilis / Pseudomonas aeruginosa
No. of isolates† / 65 / 24* / 13* / 11*
Oral/Oral Equivalent
Ampicillin / xx% / xx% / xx%
Amox/Clav / xx% / xx% / xx%
Cefazolin / xx% / xx% / xx%
Cefoxitin / xx% / xx% / xx%
Ceftriaxone / xx% / xx% / xx%
Ciprofloxacin / xx% / xx% / xx% / xx%
Levofloxacin / xx% / xx% / xx% / xx%
Nitrofurantoin / xx% / xx% / xx%
TMP/SMX / xx% / xx% / xx%
Tetracycline / xx% / xx% / xx%
Oxacillin

Gram Negative
Escherichia coli / Klebsiella pneumoniae / Proteus mirabilis / Pseudomonas aeruginosa
No. of isolates† / 65 / 24* / 13* / 11*
Oral / Oral Equivalent
Clindamycin
Erythromycin
Linezolid
IV Only
Pip/Taz / xx% / xx% / xx% / xx%
Cefepime / xx% / xx% / xx% / xx%
Ceftazidime / xx%
Gentamicin / xx% / xx% / xx% / xx%
Imipenem / xx% / xx% / xx% / xx%
Vancomycin
*Organisms 30 isolates should be interpreted with caution, because small numbers may bias group susceptibilities.†N = pooled isolates by species from urine, wound, sputum, and blood specimens. Abbreviations: MRSA = Methicillin-resistant Staphylococcus aureus, a subset of all Staph. aureus isolates. PIP/TAZ = Pipercillin/Tazobactam; TMP/SMX = Trimethoprim/sulfamethoxazole; Amox/Clav = Amoxicillin/Clavunate. /

Antibiogram for MM/DD/YY to MM/DD/YY

[Name of Nursing Home/Name of Laboratory]

Gram Negative
Escherichia coli / Klebsiella pneumoniae / Proteus mirabilis / Pseudomonas aeruginosa
No. of isolates† / 65 / 24* / 13* / 11*
Oral/Oral Equivalent
Ampicillin / xx% / xx% / xx%
Amox/Clav / xx% / xx% / xx%
Cefazolin / xx% / xx% / xx%
Cefoxitin / xx% / xx% / xx%
Ceftriaxone / xx% / xx% / xx%
Ciprofloxacin / xx% / xx% / xx% / xx%
Levofloxacin / xx% / xx% / xx% / xx%
Nitrofurantoin / xx% / xx% / xx%
TMP/SMX / xx% / xx% / xx%
Tetracycline / xx% / xx% / xx%
Oxacillin

Gram Negative
Escherichia coli / Klebsiella pneumoniae / Proteus mirabilis / Pseudomonas aeruginosa
No. of isolates† / 65 / 24* / 13* / 11*
Oral / Oral Equivalent
Clindamycin
Erythromycin
Linezolid
IV Only
Pip/Taz / xx% / xx% / xx% / xx%
Cefepime / xx% / xx% / xx% / xx%
Ceftazidime / xx%
Gentamicin / xx% / xx% / xx% / xx%
Imipenem / xx% / xx% / xx% / xx%
Vancomycin
*Organisms < 30 isolates should be interpreted with caution, because small numbers may bias group susceptibilities. †N = pooled isolates by species from urine, wound, sputum, and blood specimens. Abbreviations: MRSA = Methicillin-resistant Staphylococcus aureus, a subset of all Staph. aureus isolates. PIP/TAZ = Pipercillin/Tazobactam; TMP/SMX = Trimethoprim/sulfamethoxazole; Amox/Clav = Amoxicillin/Clavunate.
Use Avery #5302 tent cards / Use Avery #5302 tent cards

Antibiogram for MM/DD/YY to MM/DD/YY

[Name of Nursing Home/Name of Laboratory]

Gram Negative
Staphylococcus aureus
non-MRSA / Staphylococcus aureus
MRSA / Staphylococcus coag. Neg / Enterococcus sp
No. of isolates† / 3* / 11* / 6* / 25*
Oral/Oral Equivalent
Ampicillin / xx% / x% / xx% / xx%
Amox/Clav
Cefazolin / xx% / xx% / xx%
Cefoxitin
Ceftriaxone
Ciprofloxacin / x% / xx% / xx%
Levofloxacin / xx% / xx% / x% / xx%
Nitrofurantoin / xxx% / xxx% / xxx% / xxx%
TMP/SMX / xx% / xxx% / xxx%

Gram Negative
Escherichia coli / Klebsiella pneumoniae / Proteus mirabilis / Pseudomonas aeruginosa
No. of isolates† / 3* / 11* / 6* / 25*
Tetracycline / xxx% / xxx% / xx% / xx%
Oxacillin / xxx% / x% / xx%
IV Only
Linezolid / xxx% / xxx% / xxx%
Pip/Taz
Cefepime
Ceftazidime
Gentamicin / xxx% / xxx% / xx%
Imipenem
Vancomycin / xxx% / xxx% / xxx% / xxx%
*Organisms < 30 isolates should be interpreted with caution, because small numbers may bias group susceptibilities. †N = pooled isolates by species from urine, wound, sputum, and blood specimens. Abbreviations: MRSA = Methicillin-resistant Staphylococcus aureus, a subset of all Staph. aureus isolates. PIP/TAZ = Pipercillin/Tazobactam; TMP/SMX = Trimethoprim/sulfamethoxazole; Amox/Clav = Amoxicillin/Clavunate. /

Antibiogram for MM/DD/YY to MM/DD/YY[Name of Nursing Home/Name of Laboratory]

Gram Negative
Staphylococcus aureus
non-MRSA / Staphylococcus aureus
MRSA / Staphylococcus coag. Neg / Enterococcus sp
No. of isolates† / 3* / 11* / 6* / 25*
Oral/Oral Equivalent
Ampicillin / xx% / x% / xx% / xx%
Amox/Clav
Cefazolin / xx% / xx% / xx%
Cefoxitin
Ceftriaxone
Ciprofloxacin / x% / xx% / xx%
Levofloxacin / xx% / xx% / x% / xx%
Nitrofurantoin / xxx% / xxx% / xxx% / xxx%
TMP/SMX / xx% / xxx% / xxx%

Gram Negative
Escherichia coli / Klebsiella pneumoniae / Proteus mirabilis / Pseudomonas aeruginosa
No. of isolates† / 3* / 11* / 6* / 25*
Tetracycline / xxx% / xxx% / xx% / xx%
Oxacillin / xxx% / x% / xx%
IV Only
Linezolid / xxx% / xxx% / xxx%
Pip/Taz
Cefepime
Ceftazidime
Gentamicin / xxx% / xxx% / xx%
Imipenem
Vancomycin / xxx% / xxx% / xxx% / xxx%
*Organisms < 30 isolates should be interpreted with caution, because small numbers may bias group susceptibilities. †N = pooled isolates by species from urine, wound, sputum, and blood specimens. Abbreviations: MRSA = Methicillin-resistant Staphylococcus aureus, a subset of all Staph. aureus isolates. PIP/TAZ = Pipercillin/Tazobactam; TMP/SMX = Trimethoprim/sulfamethoxazole; Amox/Clav = Amoxicillin/Clavunate.

● May 2014

AHRQ Pub. No. 14-0023-8-EF