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{"sheet":"#2 M39 basic","index":1,"n_rows":13,"n_cols":7,"rows_kept":13,"cut":false,"hidden":false,"merged":[[0,2,0,5],[0,0,1,0],[0,1,1,1],[0,6,1,6]]}
[" CLSI M39 Basic Recommendations*","Additional tips / instructions for analysis and presentation of your antibiogram data for submission to LA County ","Please indicate if the antibiogram report you submitted fulfilled the CLSI M39 recommendations listed in Column A",null,null,null,"Comments"]
[null,null,"Yes","No","Don't know","Not applicable"]
["Analyze and present a cumulative antibiogram report at least annually.","Include percent susceptible (%S) data compiled from:  \n-susceptibility tests reported during the calendar year of 2023 (i.e. January 1, 2023 – December 31, 2023). \n- ALL susceptibility tests reported;  from ALL patient populations (e.g., outpatient, inpatient, ICU, pediatric, etc.) and ALL specimen sources (e.g., blood urine, etc.). "]
["Include only final, verified antimicrobial susceptibility testing (AST) results.","Do not include preliminary results that require confirmation by repeat testing with the same or a second method."]
["Include only species with AST data for ³ 30 isolates. ","However, if you have results for fewer than 30 isolates of a particular organism, enter results, if available. Data received from all facilities will be aggregated to generate the LA County multi-facility combined antibiogram. "]
["Include only diagnostic (not surveillance) isolates. ","Include only isolates from human patient specimens collected for clinical diagnostic purposes. Do not include results on isolates that were recovered as part of a surveillance culture program (e.g., MRSA), environmental cultures, or non-patient sources. "]
["Eliminate duplicates by including only the first isolate of a species/patient/analysis period, irrespective of body site or antimicrobial susceptibility profile. ","Example: if Mr. Jones had E. coli isolated from his urine twice, then once from his blood, then again from his urine during 2023, only enter the AST results for the first E. coli reported.\nSome software may eliminate duplicates using alternative rules (e.g., recount after 30 days since the previous AST). Please add comments related to this in the comment section at the end of this row."]
["Calculate the percent susceptible (%S) from antimicrobial agents routinely tested and reported, as well as those that are routinely tested but suppressed on final patient reports due to the application of selective and/or cascade reporting rules. ","Determine which data are available for analysis to generate the %S report. If some results are suppressed before the analysis occurs, the results for the suppressed agents will be skewed.  In this case the \"N\" values for suppressed drugs will be lower than the \"N\" value for the number of organisms tested.  Perform the analysis before any suppression rules are invoked, if possible (sometimes this cannot be easily done). \nYour answer to this question is critical.  If you need further clarification, please contact us at hai@ph.lacounty.gov or 213-240-7941."]
["Do not report supplemental agents selectively tested on resistant isolates only.","Do not include results from agents that are intermittently tested for highly resistant organisms or on special request (e.g., ceftaroline only tested on MRSA or ceftazidime-avibactam only tested on carbapenem-resistant Enterobacterales by physician request)."]
["Report the %S and do not include the percent intermediate (%I) in the %S statistic.","A small percentage of isolates may have MIC or zone diameters that fall in the intermediate interpretive category for a given agent.  Do not add these to the %S values."]
["*Clinical and Laboratory Standards Institute. 2022. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. M39, 5th edition. CLSI, Wayne, PA. ","\n\n"]
[]
["*Clinical and Laboratory Standards Institute. 2014. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. M39, 4th edition. CLSI, Wayne, PA."]

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["CLSI M39 Recommendations \nSupplemental Analyses and Selection Criteria Options*  ","Additional tips / instructions for analysis and presentation of your antibiogram data for submission to LA County.  ","Please indicate if the antibiogram report you submitted fulfilled the CLSI M39 recommendations listed in Column A*",null,null,null,"Comments"]
[null,null,"Yes","No","Don't know","Not applicable"]
["Staphylococcus aureus: list %S for methicillin-susceptible (MSSA) and %S for methicillin-resistant S. aureus (MRSA) subsets and list %S for all S. aureus.","List %S for MSSA and %S for MRSA separately (since their AST profiles for several agents are typically different) and list %S for all S. aureus. The \"N\" for all S. aureus will probably not equal the sum of \"N's\" for MSSA and MRSA as some patients may have both MSSA and MRSA during the reporting year.\nNote: %S for vancomycin for MRSA, MSSA, and all S. aureus should be 100% (unless you confirmed one or more isolates as vancomycin-intermediate S. aureus or VISA).  If you encounter any vancomycin-resistant S. aureus (VRSA), please call Acute Communicable Disease Control ASAP at 213-240-7941."]
["Enterococcus: list %S for E. faecalis and %S for E. faecium separately when identified to species level and list %S for all enterococci as a group. ","List %S for E. faecalis and %S for E. faecium separately (since their AST profiles for several agents are typically different) and list %S for all Enterococcus spp. \"All Enterococcus spp.\"  should include E. faecalis, E. faecium and any other Enterococcus species as well as those enterococci not identified to species level."]
["Streptococcus pneumoniae: analyze all isolates using both meningitis and nonmeningitis breakpoints, respectively, for cefotaxime, ceftriaxone, and penicillin.","For all Streptococcus pneumoniae isolates tested, regardless of body site, calculate and list %S using non-meningitis breakpoints.  Then perform a second analysis of all isolates by calculating and listing the %S using meningitis breakpoints for cefotaxime, ceftriaxone and penicillin. \nNOTE: Some laboratories may also list %S for penicillin V (oral), however such data are not requested in this survey."]
["Susceptible Dose Dependent (SDD): list %S and list %SDD for antimicrobial agent / organism combinations for which an SDD interpretive category is defined.","For cefepime and all species of Enterobacterales, daptomycin-Enterococcus faecium and ceftaroline-S. aureus, enter %SDD as appropriate if SDD interpretations are reported in your facility.  For these, the %S should only include isolates that tested S and the %SDD should only include isolates that tested SDD.  Do not combine the two. "]
["Cefazolin: list %S using both the systemic and urine breakpoints for E. coli, K. pneumoniae and P. mirabilis, if appropriate for your facility.","For cefazolin and all E. coli, K. pneumoniae and P. mirabilis isolates tested, regardless of body site, calculate and list %S using systemic breakpoints. Then perform a second analysis of all isolates by calculating  and listing %S using  urine breakpoints if these are applied for interpreting results reported in your facility. If neither current CLSI urine nor systemic breakpoints are used, refrain from entering data for cefazolin and list in the \"notes\" box here the breakpoints you are using for cefazolin."]
["Nitrofurantoin: compile and list %S from testing urine isolates only. ","Enter %S from urine isolates only, if possible."]
["Clindamycin and Staphylococcus aureus\n%S for clindamycin should reflect results following performance of testing for inducible clindamycin resistance.","For clindamycin, the %S should be compiled following performance of tests for inducible clindamycin resistance for isolates that are erythromycin-R and clindamycin-S prior to induction."]
["Clindamycin and Streptococcus pneumoniae\n%S for clindamycin should reflect results following performance of testing for inducible clindamycin resistance."]
["Clindamycin and Beta Streptococcus\n%S for clindamycin should reflect results following performance of testing for inducible clindamycin resistance."]
["Aminoglycosides and Pseudomonas aeruginosa\nAs of 2023, CLSI no longer recommends reporting gentamicin and it is recommended that amikacin should be reported only on urine isolates of P. aeruginosa.","Do not enter results for gentamicin and P. aeruginosa.  Indicate in the comments column G here if your results for amikacin were from urine isolates only."]
["What software  (computer program) was used to compile your %S data?","Describe in \"notes\" in cell G12 how you analyzed your data.  For example, options may include:  use of a program provided with your automated AST instrument; download from your LIS to Excel; program provided with your electronic health record or hospital information system software. Please provide as much detail as possible, including if %S data for certain antimicrobial agent / organism combinations are likely incomplete due to known suppression rules."]
["*Clinical and Laboratory Standards Institute. 2022. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data. M39, 5th edition. CLSI, Wayne, PA.\n"]

{"sheet":"#4 Gram Negative","index":3,"n_rows":20,"n_cols":50,"rows_kept":20,"cut":false,"hidden":false,"merged":[[0,18,0,19],[0,20,0,21],[0,38,0,39],[0,36,0,37],[0,40,0,41],[0,32,0,33],[0,42,0,43],[0,44,0,45],[0,46,0,47],[0,48,0,49],[0,22,0,23],[0,24,0,25],[0,26,0,27],[0,28,0,29],[0,30,0,31],[0,34,0,35],[0,16,0,17],[0,2,0,3],[0,6,0,7],[0,8,0,10],[0,11,0,13],[0,14,0,15],[0,4,0,5]]}
[null,null,"Amikacin",null,"Ampicillin",null,"Amp-sulbactam",null,"Cefazolin",null,null,"Cefepime",null,null,"Ceftazidime",null,"Ceftriaxone/ Cefotaxime",null,"Ceftazidime-avibactam",null,"Ceftolozane-tazobactam",null,"Ciprofloxacin",null,"Doripenem",null,"Ertapenem",null,"Gentamicin",null,"Imipenem",null,"Imipenem-relebactam",null,"Levofloxacin",null,"Meropenem",null,"Meropenem-vaborbactam",null,"Minocycline",null,"Nitrofurantoin",null,"Piperacillin‐ tazobactam",null,"Trimethoprim‐ sulfmethoxazole",null,"Tobramycin"]
["Organism Name","Total number of isolates (N)","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S \nUR* ","%S \nSYS**","N isolates tested","%S ","%SDD‡","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S"]
["Acinetobacter baumannii"]
["Citrobacter freundii"]
["Citrobacter koseri"]
["Klebsiella (Enterobacter) aerogenes"]
["Enterobacter cloacae complex"]
["Enterobacter spp.†",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Escherichia coli"]
["Klebsiella oxytoca"]
["Klebisella pneumoniae"]
["Morganella morganii"]
["Proteus mirabilis"]
["Pseudomonas aeruginosa"]
["Serratia marcescens"]
["Stenotrophomonas maltophilia"]
["*UR, urine breakpoint (S, ≤ 16 µg/ml or ≥15 mm); **SYS, systemic breakpoint (S, ≤2 µg/ml or ≥23 mm); calculate %S from ALL isolates regardless of specimen source using urine breakpoints and then again using systemic breakpoints, respectively"]
["NT: not tested"]
["† Enterobacter isolates not ID'd to species or Enterobacter species other than those listed"]
["‡SDD = susceptible dose-dependent"," "]

{"sheet":"#5 Gram Positive","index":4,"n_rows":17,"n_cols":32,"rows_kept":17,"cut":false,"hidden":false,"merged":[[0,30,0,31],[0,12,0,13],[0,14,0,15],[0,18,0,19],[0,20,0,21],[0,22,0,23],[0,26,0,27],[0,28,0,29],[0,16,0,17],[0,24,0,25],[0,2,0,3],[0,4,0,5],[0,6,0,7],[0,8,0,9],[0,10,0,11]]}
[null,null,"Ampicillin",null,"Ceftaroline",null,"Ceftriaxone",null,"Ciprofloxacin",null,"Clindamycin",null,"Daptomycin",null,"Doxycycline",null,"Erythromycin",null,"Levofloxacin",null,"Linezolid",null,"Nitrofurantoin",null,"Oxacillin",null,"Penicillin",null,"Trimethoprim‐ sulfamethoxazole",null,"Vancomycin"]
["Organism Name","Total number of isolates (N)","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates\n tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S","N isolates tested","%S"]
["Enterococcus faecalis"]
["Enterococcus faecium"]
["Enterococcus spp.†"]
["Staphylococcus aureus (ALL)"]
["Methicillin‐resistant Staphylococcus aureus"]
["Methicillin‐susceptible Staphylococcus aureus"]
["Streptococcus agalactiae (Group B Strep)"]
["Streptococcus pneumoniae (non-meningitis)††",null,"*"]
["Streptococcus pneumoniae (meningitis)††"]
["Streptococcus pyogenes (Group A Strep)"]
[]
["NT: not tested"]
["*record amoxicillin"]
["† include %S from E. faecalis, E. faecium, other Enterococcus spp. and enterococci not identified to species level combined"]
["†† calculate %S from ALL pneumococcus regardless of specimen source using non-meningitis (or routine) breakpoints and then again using meningitis breakpoints "]