Minimum Acceptable Susceptibility of Empirical Antibiotic Regimens for Gram-Negative Bloodstream Infections: A Survey of Clinical Pharmacists

Background There is a paucity of data describing the minimum acceptable susceptibility (MAS) of empirical antimicrobial regimens based on severity of illness, prognosis, and practitioner level of comfort. Objective The purpose of this study was to determine the MAS used by pharmacists involved in antimicrobial decision making for gram-negative bloodstream infections. Methods This cross-sectional survey targeted infectious diseases and/or critical care pharmacists. The 11-item survey was distributed electronically in September and October 2014. Survey respondents were asked to indicate a 2-digit number (between 59% and 99%) representing their MAS targets for each clinical scenario (3 cases of gram-negative bloodstream infection of varying complexity and prognosis and 1 control scenario of uncomplicated cystitis). The median MAS were reported by prognosis as estimated by the Bloodstream Infection Mortality Risk Score (BSIMRS) and respondent characteristics. Results Among 316 participant pharmacists, 209 (66%) and 52 (17%) identified infectious diseases and critical care as specialty practice areas, respectively. The median MAS was 90% for both case 1 (poor prognosis; BSIMRS: 13) and case 2 (guarded prognosis; BSIMRS: 8), 85% for case 3 (good prognosis; BSIMRS: 2), and 80% for case 4 (uncomplicated cystitis; BSIMRS: 0). There was a significant increase in median MAS as BSIMRS increased from 0 to 2 (P

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