AMS

Surveillance/Antibiogram
 Objectives

 Sample management
 Use of CLSI
 How to use microbiology data to prepare antibiogram
Sample Management
Exercise
 What are the most common Microbiology samples?

 What are the most frequent causes of samples rejection?

 Rules for Collecting a Microbiology Specimen

 Whenever possible, collect the specimen before antibiotic

therapy.
 Collect material from where the suspected organism will most
likely be found. OR the specimen must represent the infected site.
 Observe aseptic techniques in collection of all specimens.
 Consider stage of the disease.
 Instruct patients clearly.
 Use proper containers and transport media.
 Deliver specimens promptly.
 Provide sufficient information to the laboratory.
Instructions for Proper Collection of a Microbiology Specimen
 Right amount and type of specimen is required: Specimen type depends on the
target pathogen. A cervical swab, for example, is ideal for isolation of N.
gonorrhoeae as opposed to a vaginal swab.
 Use the recommended specimen collection container, and if need be use
preservative or transport medium.
 Timing is important when collecting microbiology specimen .
 Ensure aseptic and safe methods of collection to avoid contamination and accidental
infection.
 Label specimen container correctly.
 Most specimens collected outside of the lab should be transported at 2–8°C.
 Make arrangements for processing specimens that are urgent and those collected
outside normal working hours, e.g., blood cultures collected by medical staff.
 Labeling Specimens
 Patient’s name and contacts
 Patient’s age and sex
 Patient’s residence
 Patient’s date of admission (if applicable)
 Clinical specimen type
 Unique ID number (Research/Outbreak)
 Specimen type
 Date, time, and place of collection
 Requesting clinician name and contacts
 Microbiological Samples Transportation
 Should be prompt after collection
 Inoculate bacterial culture media within the same they are collected even if
appropriate holding medium or refrigeration is maintained.
 Some bacteria are sensitive to ambient conditions
 Reliable detection of these species requires immediate processing. Delays of up
to 6 hours result in some loss of CFU when transport media are used.
 Longer delays, even with the use of transport media, result in significant loss of
organisms.
 Samples Reception
 Sample reception is an important preanalytical procedure which if not
well organized can compromise the integrity of the entire workflow.
 A well documented procedure on samples reception and rejection criteria
enhances and guarantees traceability of samples.
 A good samples reception SOP should contain the following details:
Sample acceptation or rejection criteria
 How to log the samples in the physical or electronic register
 How to assign lab ids
 Handling urgent samples
 Clinical data for some investigations
 General Samples Rejection Criteria
 Unlabeled or improperly labeled specimens
 Samples with labels that do not match details on the request form
 Request forms that have scanty patient information or are
incomplete; information on tests requested or clinical information of
the patient is missing
 Specimen has been collected in the wrong container
 Samples are leaking
 Request forms without specimens and vice versa
 Test order canceled by clinician or wrong order provided
 Specimen delayed in transit
 Rejection Criteria (cont…)

 Multiple samples collected from the same patient, same day

 Sample received after 2 hours without transport media

 Dry Swabs- If received in the lab after 1 hour
 Collection site not stated
 Summary of Key Messages

 Whenever possible, collect the specimen before antibiotic

therapy
 Aseptic techniques are key in microbiology samples
collection
 All samples must be accompanied by well completed
request forms
Collecting data on the use of antimicrobials
and microbiology
 Collecting data on the use of antimicrobials

The purpose for collecting data is to:

 assess the extent and quality of
antibiotic use
 Identify problematic prescribing
practices
 Identify good prescribing practices
that needs re-enforcing.
 Compare appropriate use across
healthcare facilities and within a
healthcare facility, department or
ward over time
Antimicrobial use and microbiology data collection
 Data is collected during the planning stage for AMS
programme
 Collecting data on the use of antimicrobials helps to provide
baseline information and evaluate AMS interventions.
 Daily routine data on in-patient antimicrobial consumption

 Periodic data on overall antibiotic consumption, antibiotic

use and antibiotic audit data is collected
 Collecting data on the use of antimicrobials cont’d

 Types of antibiotic data:

 Antibiotic consumption

 Antibiotic use

 Antibiotic audit data

 They are used to provide baseline information and evaluate

AMS interventions
Implementation of STG and AWaRe Classification

 Commonly used antibiotics are classified into three groups-

ACCESS, WATCH and RESERVE
 Recommends when to use the antibiotics in each category
 It provides a tool to support antibiotic monitoring and AMS
activities
 Baseline data on antibiotic use according to AWaRe
Categorization is collected during planning
 Note:Please refer to module 4 for a further discussion on
AWaRe categorization.
Collecting antimicrobial data and use of microbiology results
For most patients empiric antibiotic treatment is clinical
assessment based & not microbiology results based .
Treatment is chosen according to commonest microbes
likely to cause different infections
Collecting antimicrobial data and use of microbiology results

 A strategy that works when antibiotic resistance rates are low

 Also works when there is AMR surveillance that can guide
recommendations for empirical antibiotic treatment.
 Microbiology results informs appropriate use of antibiotics
under the ACCESS category of AWaRe categorization.
 Microbiology ensures the use of first & second-line
 antibiotics are used whenever possible. Data on used
antibiotics guided by microbiology results helps in the
planning process of establishing an AMS Programme.
A sample of a picture showing how a laboratory Action Plan
and how it can promote AMS Programme

Sample antibiogram
Thank you!