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Medication-associated Module
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Antimicrobial Use and Resistance (AUR) Option
Antimicrobial Use and Resistance (AUR) Option
Introduction
Rates of resistance to antimicrobial agents continue to increase at hospitals in the United
States.1 The two main reasons for this increase are patient-to-patient transmission of
resistant organisms and selection of resistant organisms because of antimicrobial
exposure.2 Previous studies have shown that feedback of reliable reports of rates of
antimicrobial use and resistance to clinicians can improve the appropriateness of
antimicrobial usage.3-5
The goal of this National Healthcare Safety Network (NHSN) AUR Option is to provide
a mechanism for facilities to report and analyze antimicrobial use and/or resistance as
part of antimicrobial stewardship efforts at their facility.6 This module contains two
options, one focused on antimicrobial usage and the second on antimicrobial resistance.
To participate in either option, the facility must coordinate with their software provider to
configure their system to enable the generation of standard formatted file(s) to be
imported into NHSN. The format provided for data submission follows the HL7 Clinical
Document Architecture (CDA).7 Manual data entry is not available for the AUR Module.
1. Antimicrobial Use (AU) Option
Objectives: The primary objective of the Antimicrobial Use option is to facilitate riskadjusted inter- and intra-facility benchmarking of antimicrobial usage. A secondary
objective is to evaluate trends of antimicrobial usage over time at the facility and national
levels.
Methodology: The primary antimicrobial usage metric reported to this module is
antimicrobial days per 1000 days present. An antimicrobial day (also known as day of
therapy) is defined by any amount of a specific antimicrobial agent administered in a
calendar day to a particular patient as documented in the electronic medication
administration record (eMAR) and/or bar coding medication record (BCMA) (refer to
Numerator Data Section); all antimicrobial days for a specific agent administered across a
population are summed in aggregate. 8-11 Days present are defined as the aggregate
number of patients housed to a patient-care location or facility anytime throughout a day
during a calendar month (refer to Denominator Data Section). For each facility, the
numerator (i.e., antimicrobial days) is aggregated by month for each patient-care location
and overall for inpatient areas facility-wide (i.e., facility-wide-inpatient). Similarly, the
denominator (i.e., days present) is calculated for the corresponding patient-care-locationmonth or facility-wide-inpatient-month. A secondary antimicrobial usage metric for
facility-wide-inpatient also reported to this module is antimicrobial days per 1000
admissions. The numerator and denominators are further defined below and must adhere

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to the data format prescribed by the HL7 CDA Implementation Guide developed by the
CDC and HL7.7
Settings: NHSN encourages submission of all NHSN-defined inpatient locations,
facility-wide-inpatient, and select outpatient acute-care settings (i.e., outpatient
emergency department, pediatric emergency department, 24-hour observation area) at
each facility (Table 1). The patient-care areas may include adult, pediatric, or neonatal
units as defined by NHSN Codes (Chapter 15 CDC Locations and Descriptions). A
comprehensive submission will enable a facility to optimize inter- and/or intra-facility
comparisons among specific wards, combined wards, and hospital-wide data. The
optional and minimal requirements for participation in the Antimicrobial Use option are
listed in Table 1.
The minimal requirement for participation is submission of data for all four of the
following locations (if applicable to facility): 1) all medical critical care units(s) and
surgical critical care units(s) [if combined units, then report as medical/surgical critical
care unit(s)]; 2) all medical ward(s) and surgical ward(s) [if combined wards, then report
as medical/surgical ward(s)]; 3) at least one specialty care area; and 4) facility-wideinpatient (both days present and admissions must be reported for this location).
Table 1. CDC Locationa: Optional and Minimal Requirements for AU Option
Inpatient Locations
Minimal Submission Requirements (if applicable for facility)
Requirement:
Adult Critical Care Units
For facilities with only adult critical care unit(s): submit all medical
critical care unit(s) and surgical critical care units(s) [if combined units,
then report as medical/surgical critical care unit(s)].

Pediatric Critical Care Units

For facilities with adult and pediatric critical care unit(s), the minimum
requirement is the submission of data from all adult and pediatric
critical care locations.
Requirement:
For facilities with only pediatric critical care unit(s): submit all medical
critical care unit(s) and surgical critical care units(s) [if combined units,
then report as medical/surgical critical care unit(s)].

Neonatal Units
Inpatient Specialty Care Areas
Inpatient Adults Wards

For facilities with adult and pediatric critical care unit(s), the minimum
requirement is the submission of data from all adult and pediatric
critical care locations.
Optional (i.e., no minimal submission requirement)
Requirement: At least one Specialty Care Area
Requirement:
For facilities with only adult medical and surgical ward(s), submit all
medical ward(s) and surgical ward(s) [if combined wards, then report as
medical/surgical ward(s)].
For facilities with adult and pediatric medical and surgical ward(s), the

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Inpatient Locations

Inpatient Pediatric Wards

Step Down Units
Operating Rooms
Long Term Care
Facility-Wide
Facility-wide-inpatient
Outpatient Locations
Select Acute Care Settings
Outpatient Emergency Department
Pediatric Emergency Department
24-Hour Observation Area

Minimal Submission Requirements (if applicable for facility)
minimum requirement is the submission of data from all adult and
pediatric medical and surgical ward locations.
Requirement:
For facilities with only pediatric medical and surgical ward(s), submit
all medical ward(s) and surgical ward(s) [if combined wards, then
report as medical/surgical ward(s)].
For facilities with adult and pediatric medical and surgical ward(s), the
minimum requirement is the submission of data from all adult and
pediatric medical and surgical ward locations.
Optional (i.e., no minimal submission requirement)
Optional (i.e., no minimal submission requirement)
Optional (i.e., no minimal submission requirement)
Minimal Submission Requirements (if applicable for facility)
Requirement: Facility-wide-inpatient
Minimal Submission Requirements (if applicable for facility)
Optional (i.e., no minimal submission requirement)

a

CDC Location: A CDC-defined designation given to a patient-care area housing patients who have
similar disease conditions or who are receiving care for similar medical or surgical specialties. Each facility
location that is monitored is “mapped” to one CDC Location. The specific CDC Location code is
determined by the type of patients cared for in that area according to the 80% Rule. That is, if 80% of
patients are of a certain type (e.g., pediatric patients with orthopedic problems), then that area is designated
as that type of location (in this case, an Inpatient Pediatric Orthopedic Ward).

Requirements:
An acceptable minimal month of data includes:
a. Data submitted for all four of the following locations (if applicable to facility): 1) all
medical critical care unit(s) and surgical critical care unit(s) [if combined units, then
report as medical/surgical critical care unit(s)]; 2) all medical ward(s) and surgical
ward(s) [if combined wards, then report as medical/surgical ward(s)]; 3) at least one
specialty care area; and 4) facility-wide-inpatient (both days present and admissions must
be reported for this location).
b. Each month, the facility must choose to monitor antimicrobial use data on the Patient
Safety Monthly Reporting Plan (CDC 57.106)
c. All data fields outlined in the Table of Instructions (Appendix A) for the AU option are
completed via CDA for each location.
Numerator Data (Antimicrobial Days):
Antimicrobial Days (Days of Therapy): Defined as the aggregate sum of days for which
any amount of a specific antimicrobial agent was administered to individual patients as
documented in the eMAR and/or BCMA.8-11 Appendix B provides a list of antimicrobial
agents. Aggregate antimicrobial days are reported monthly for inpatient locations,
facility-wide-inpatient, and select outpatient acute-care settings (e.g., outpatient
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emergency department, pediatric emergency department, 24-hour observation area) for
select antimicrobial agents and stratified by route of administration (e.g., intravenous,
intramuscular, digestive and respiratory). Refer to Table 2 and 3 for definitions of drugspecific antimicrobial days and stratification based on route of administration. For
example, a patient to whom 1 gram vancomycin is administered intravenously twice daily
for three days will be attributed three “Vancomycin Days (total)” and three “Vancomycin
Days (IV)” when stratified by intravenous route of administration. Appendix C provides
additional examples for the calculation of antimicrobial days. Table 4 summarizes the
data elements for numerator calculation. Please note that “zero” should be recorded
when no aggregate usage occurred during a given reporting period for a specific
antimicrobial agent at a facility in which the agent is used, while “not applicable” should
be recorded when data are not available for a specific antimicrobial agent at a facility
(e.g., the agent can’t be electronically captured at that facility). A value (e.g., a specific
number, “zero”, or “not applicable”) should be reported for every antimicrobial agent
listed in Appendix B.
Table 2. Classification and Definitions of Route of Administrations for Antimicrobial Days
Classification:
Definitionb,c
Route of Administrationa
Intravenous
An intravascular route that begins with a vein.
Intramuscular
A route that begins within a muscle.
Digestive Tract
A route that begins anywhere in the digestive tract extending from the
mouth through rectum.
Respiratory Tract
A route that begins within the respiratory tract, including the oropharynx
and nasopharynx.
a
Other routes of administration are excluded in this module (e.g., antibiotic locks, intraperitoneal,
intraventricular, irrigation, topical).
b
Definitions per SNOMED Reference Terminology
c
Mapping of standardized terminology for route of administration are provided via the hai-voc
spreadsheet.
Table 3. Example Stratification of Antimicrobial Days by Route of Administration
Month/
YearLocation

Antimicrobial
Agent

Drug-specific Antimicrobial Days
Total

a

IV

IM

Digestiveb

Respiratory

MonthTobramycin Tobramycin
Tobramycin
Tobramycin
Tobramycin
Tobramycin
Year/
Days
Days
Days
Days
Days
Location
(Total)
(IV)
(IM)
(Digestive)
(Respiratory)
a
Drug-specific antimicrobial days (total) attributes one antimicrobial day for any of the specified
routes of administration. For example, a patient to whom tobramycin was administered
intravenously and via a respiratory route on the same day would be attributed “one Tobramycin
Day (Total)”; the stratification by route of administration would be “one Tobramycin Day (IV)”
and “one Tobramycin Day (Respiratory)”.
b
For purposes of example of route stratification only (tobramycin is not FDA approved for
administration via the digestive route).

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Table 4. Data Elements for Antimicrobial Days
Antimicrobial
Agents

Data source

Location

Time Unit

Antimicrobial Days
Defined as select antimicrobial agents and stratified by route of administration (i.e.,
intravenous, intramuscular, digestive and respiratory). Refer to Appendix B for a complete
list of antimicrobial agents. The list of select antimicrobial agents will evolve with time as
new agents become commercially available. Topical antimicrobial agents are not included in
this module option.
Antimicrobial days are derived from administered data documented in the eMAR and/or
BCMA only. Usage derived from other data sources (e.g., pharmacy orders, doses dispensed,
doses billed) cannot be submitted.
Antimicrobial days are aggregated for inpatient locations, facility-wide-inpatient, and select
outpatient acute-care settings (i.e., outpatient emergency department, pediatric emergency
department, 24-hour observation area) per NHSN location definitions.
Antimicrobial days for a specific antimicrobial agent and stratification by route of
administration are aggregated monthly per location.

Denominator Data (Days Present and Admissions): The numerator will be analyzed
against the denominator of days present and also admissions for facility-wide-inpatient
only. The denominators are further defined below.
Days present: Defined as time period during which a given patient is at risk for
antimicrobial exposure for a given patient location. The definition of days present differs
from conventional definition of patient days used in other NHSN modules and that
recommended by the SHEA/HIPAC guidance for surveillance of multidrug-resistant
organisms.12 Days present is further defined below in context of calculation for patient
care location specific analyses and facility-wide-inpatient analyses. Please note that a
separate calculation for days present is required for patient-care location compared to
facility-wide-inpatient.
For patient-care location-specific analyses, days present is calculated as the
number of patients who were present for any portion of each day of a calendar
month for a patient-care location; the aggregate measure is calculated by
summing up all of the days present for that location and month. The day of
admission, discharge, and transfer to and from locations will be included in days
present. For example, a patient admitted to the medical ward on Monday and
discharged two days later on Wednesday will be attributed three days present on
that medical ward. Another example, on the day a patient is transferred from a
medical critical-care unit to a medical ward, the patient will be attributed one day
present on the medical critical care unit as well as one day present on the medical
ward. Similarly, a patient’s exposure to the operating room or emergency
department will be included in days present for these types of units. However,
one patient can account for only one day present for a specific location per
calendar day (e.g., one patient cannot contribute more than 1 day present to any
one unique location on the same day, but can contribute a day present to two
different locations on the same day). For example, a patient transferred from the

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surgical ward to the operating room and back to the surgical ward in a calendar
day contributes one day present to the surgical ward and one day present to the
operating room.
For facility-wide-inpatient analyses, days present is calculated as the number of
patients who were present for any portion of each day of a calendar month at the
facility-wide-inpatient location; the aggregate measure is calculated by summing
up all of the days present for facility-wide-inpatient for a given month. Thus, a
sum of days present from location-specific analyses would be higher than days
present for the facility, because transfers between wards can account for multiple
location “days present” for a given patient. Therefore, the individual summing of
days present for location-specific analyses to achieve facility-wide-inpatient is not
permissible. The calculation must be a separate summation for facility-wideinpatient analyses.
Admissions: Admissions are defined as the aggregate number of patients admitted to the
facility (i.e., facility-wide-inpatient) starting on first day of each calendar month through
the last day of the calendar month. This is the same definition for admissions utilized in
the NHSN MDRO/CDI Module. In the AU option, admissions are reported only for
facility-wide-inpatient.
Table 5. Location-specific and Facility-wide-inpatient Metrics
Metric Collected
Metric Definition
Patient Care Location-Specific Analyses
Antimicrobial
Drug-specific antimicrobial days per
Days/
patient-care location per month/Days
present per patient-care location per
Days present
month

Facility-wide-inpatient Analyses
Antimicrobial
Drug-specific antimicrobial days for a
Days/
facility per month/Days present per
facility-wide-inpatient per month
Days present

Antimicrobial
Days/
Admissions

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Drug-specific antimicrobial days for a
facility per month/Admissions per
facility-wide-inpatient per month

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Comments
One patient can contribute only
one day present per calendar day
for each specific location.
Summed total may be higher
when compared to facility-wide
measure (reflecting transfers
between locations).
One patient can contribute only
one day present per calendar day
for a facility. Thus, one
denominator is obtained for an
entire facility. The day present
measure for facility-wideinpatient may be lower when
compared to sum total from
location-specific comparison.
Only calculated for facility-wideinpatient for AU Option.

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Data Analyses:
Antimicrobial use data are expressed as incidence density rates of antimicrobial days per
days present stratified by patient-care location and facility-wide-inpatient.
Antimicrobials may be grouped during analysis by route of administration, spectrum of
activity, therapeutic indication, or drug classification. A secondary metric, antimicrobial
days per admissions, will also be analyzed for facility-wide-inpatient.
2. Antimicrobial Resistance Option
Decisions regarding the Antimicrobial Resistance option are still under consideration,
and the timeline for launching will be updated in NHSN E-News and on the NHSN AUR
website.

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References
1. Hidron AI, Edwards JR, Patel J, et al. Antimicrobial-resistant pathogens
associated with healthcare-associated infections: annual summary of data reported
to the National Healthcare Safety Network at the Centers for Disease Control and
Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996-1011.
2. Schwartz MN. Use of antimicrobial agents and drug resistance. N Eng J Med
1997;337:491-2.
3. Ansari F, Gray K, Nathwani D, et al. Outcomes of an intervention to improve
hospital antibiotic prescribing; interrupted time series with segmented regression
analysis. J Antimicrob Chemother 2003;52:842-8.
4. Solomon DH, Van Houten L, Glynn RJ. Academic detailing to improve use of
broad-spectrum antibiotics at an academic medical center. Arch Inter Med
2001;161:1897-902.
5. Fraser GL, Stogsdill P, Dickens JD Jr, et al. Antibiotic optimizations: an
evaluation of patient safety and economic outcomes. Arch Inter Med 1997;1571689-94.
6. Dellit TH, Owens RC, McGowan JE, et al. Infectious Diseases Society of
America and the Society for Healthcare Epidemiology of America Guidelines for
Developing an Institutional Program to Enhance Antimicrobial Stewardship. Clin
Infect Dis 2007;44:159-77.
7. National Healthcare Safety Network (NHSN) Patient Safety Component: Clinical
Document Architecture. www.cdc.gov/nhsn/CDA_eSurveillance.html
8. Schwartz DN, Evans RS, Camins B, et al. Deriving measures of intensive care
unit antimicrobial use from computerized pharmacy data: methods, validation,
and overcoming barriers. Infect Control Hosp Epidemiol 2011;32:472-80.
9. Polk RE, Fox C, Mahoney A, Letcavage J, MacDougall C. Measurement of adult
Antibacterial Drug Use in 130 US Hospitals: Comparison of Defined Daily Dose
and Days of Therapy. Clin Infect Dis 2007;44:664-70.
10. Kuster SP, Ledergerber B, Hintermann A, et al. Quantitative antibiotic use in
hospitals: comparison of measurements, literature review, and recommendations
for standards of reporting. Infection 2008; 6:549-59.
11. Berrington A. Antimicrobial prescribing in hospitals: be careful what you
measure. J Antimicrob Chemother 2010:65:163-168.
12. Cohen AL, Calfee D, Fridkin SK, et al. Recommendations for metrics for
multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position
paper. Infect Control Hosp Epidemiol 2008:29:901-13.
13. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for
Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement.
M100-S21. Vol. 31. No 1, January 2011.

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Appendix A. Table of Instructions: Antimicrobial Use
Data Field
Facility identifier
Month
Year
Location

Numerator:
Antimicrobial days per
month per location

Denominator:

Instructions for CDA of Antimicrobial Use Data
Required. Must be assigned to facility and included in the importation file prior to
submission to CDC.
Required. Record the 2-digit month during which the data were collected for this
location.
Required. Record the 4-digit year during which the data were collected for this
location.
Required. Record location; must be (if applicable to facility): 1) all medical
critical care unit(s) and surgical critical care unit(s) [if combined units, then report
as medical/surgical critical care unit(s)]; 2) all medical ward(s) and surgical
ward(s) [if combined wards, then report as medical/surgical ward(s)]; 3) at least
one specialty care area; and 4) facility-wide-inpatient
Required.
Antimicrobial days are defined as the aggregate sum of the days of exposure for
which a specific antimicrobial was administered. These are required to be
extracted from electronic medication administration record (eMAR) and/or bar
coding medication record (BCMA). Antimicrobials days will be collected for
select antimicrobial agents (refer to Appendix B) and stratified by route of
administration.
Required.

Days present

Days present is defined as risk for antimicrobial exposure per time unit of analysis
stratified by location. For patient-care location-specific analyses,
days present is calculated as the number of patients who were present for any
portion of each day of a calendar month for a patient-care location. For facilitywide-inpatient analyses, days present is calculated as the number of patients who
were present for any portion of each day of a calendar month at the facility-wideinpatient location.

Admissions

Admissions are defined as the aggregate number of patients admitted to the facility
(i.e., facility-wide-inpatient) starting on first day of each calendar month through
the last day of the calendar month. In the AU Option, admissions are only
reported for facility-wide-inpatient.

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Appendix B. List of Antimicrobials13
Please note that mapping of standardized terminology (RXNORM) are provided via the
hai-voc spreadsheet.

Antimicrobial Agent
AMANTADINE

Antimicrobial
Category
Anti-influenza

AMIKACIN

Antibacterial

Antimicrobial
Classa
M2 ion channel
inhibitors
Aminoglycosides

AMOXICILLIN

Antibacterial

Penicillins

Aminopenicillin

AMOXICILLIN/
CLAVULANATE
AMPHOTERICIN B

Antibacterial

Penicillins

Β-lactam/ Β-lactamase
inhibitor combination

Antifungal

Polyenes

AMPHOTERICIN B
LIPOSOMAL
AMPICILLIN

Antifungal

Polyenes

Antibacterial

Penicillins

Aminopenicillin

AMPICILLIN/
SULBACTAM
ANIDULAFUNGIN

Antibacterial

Penicillins

Β-lactam/ Β-lactamase
inhibitor combination

Antifungal

Echinocandins

AZITHROMYCIN

Antibacterial

Macrolides

AZTREONAM

Antibacterial

Monobactams

CASPOFUNGIN

Antifungal

Echinocandins

CEFACLOR

Antibacterial

Cephalosporins

Cephalosporin 2rd generation

CEFADROXIL

Antibacterial

Cephalosporins

Cephalosporin 1st generation

CEFAZOLIN

Antibacterial

Cephalosporins

Cephalosporin 1st generation

CEFDINIR

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFDITOREN

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFEPIME

Antibacterial

Cephalosporins

Cephalosporin 4th generation

CEFIXIME

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFOTAXIME

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFOTETAN

Antibacterial

Cephalosporins

Cephamycin

CEFOXITIN

Antibacterial

Cephalosporins

Cephamycin

CEFPODOXIME

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFPROZIL

Antibacterial

Cephalosporins

Cephalosporin 2rd generation

CEFTAROLINE

Antibacterial

Cephalosporins

CEFTAZIDIME

Antibacterial

Cephalosporins

Cephalosporin with antiMRSA activity
Cephalosporin 3rd generation

CEFTIBUTEN

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

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CEFTIZOXIME

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFTRIAXONE

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFUROXIME

Antibacterial

Cephalosporins

Cephalosporin 2rd generation

CEPHALEXIN

Antibacterial

Cephalosporins

Cephalosporin 1st generation

CHLORAMPHENICOL

Antibacterial

Phenicols

CIPROFLOXACIN

Antibacterial

Fluoroquinolones

CLARITHROMYCIN

Antibacterial

Macrolides

CLINDAMYCIN

Antibacterial

Lincosamides

COLISTIMETHATE

Antibacterial

Polymyxins

DAPTOMYCIN

Antibacterial

Lipopeptides

DICLOXACILLIN

Antibacterial

Penicillins

DORIPENEM

Antibacterial

Carbapenems

DOXYCYCLINE

Antibacterial

Tetracyclines

ERTAPENEM

Antibacterial

Carbapenems

ERYTHROMYCIN

Antibacterial

Macrolides

ERYTHROMYCIN/
SULFISOXAZOLE

Antibacterial

FIDAXOMICIN

Antibacterial

Folate pathway
inhibitors/
Sulfonamides
Macrocyclic

FLUCONAZOLE

Antifungal

Azoles

FOSFOMYCIN

Antibacterial

Fosfomycins

GEMIFLOXACIN

Antibacterial

Fluoroquinolones

GENTAMICIN

Antibacterial

Aminoglycosides

IMIPENEM/
CILASTATIN
ITRACONAZOLE

Antibacterial

Carbapenems

Antifungal

Azoles

LEVOFLOXACIN

Antibacterial

Fluoroquinolones

LINEZOLID

Antibacterial

Oxazolidinones

MEROPENEM

Antibacterial

Carbapenems

METRONIDAZOLE

Antibacterial

Nitroimidazoles

MICAFUNGIN

Antifungal

Echinocandins

MINOCYCLINE

Antibacterial

Tetracyclines

MOXIFLOXACIN

Antibacterial

Fluoroquinolones

NAFCILLIN

Antibacterial

Penicillins

NITROFURANTOIN

Antibacterial

Nitrofurans

OSELTAMIVIR

Anti-influenza

Neuraminidase

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Penicillinase-stable penicillins

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inhibitors
OXACILLIN

Antibacterial

Penicillins

Penicillinase-stable penicillins

PENICILLIN G

Antibacterial

Penicillins

Penicillin

PENICILLIN V

Antibacterial

Penicillins

Penicillin

PIPERACILLIN

Antibacterial

Penicillins

Ureidopenicillin

PIPERACILLIN/
TAZOBACTAM
POLYMYXIN B

Antibacterial

Penicillins

Β-lactam/ Β-lactamase
inhibitor combination

Antibacterial

Polymyxins

POSACONAZOLE

Antifungal

Azoles

QUINUPRISTIN/
DALFOPRISTIN
RIFAMPIN

Antibacterial

Streptogramins

Antibacterial

Rifampin

RIMANTADINE

Anti-influenza

SULFAMETHOXAZOLE/
TRIMETHOPRIM
SULFISOXAZOLE

Antibacterial

TELAVANCIN

Antibacterial

M2 ion channel
inhibitors
Folate pathway
inhibitors
Folate pathway
inhibitors
Lipo-glycopeptides

TELITHROMYCIN

Antibacterial

Ketolides

TETRACYCLINE

Antibacterial

Tetracyclines

TICARCILLIN/
CLAVULANATE
TIGECYCLINE

Antibacterial

Penicillins

Antibacterial

Glycylcyclines

TINIDAZOLE

Antibacterial

Nitroimidazoles

TOBRAMYCIN

Antibacterial

Aminoglycosides

VANCOMYCIN

Antibacterial

Glycopeptides

VORICONAZOLE

Antifungal

Azoles

ZANAMIVIR

Anti-influenza

Neuraminidase
inhibitors

a

Antibacterial

Adapted from CLSI January 2011

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Appendix C. Example Calculations of Antimicrobial Days
Example 1. Example eMAR and Calculation of Antimicrobial Days
This example illustrates the calculation of antimicrobial days from a patient receiving
meropenem 1gram intravenously every 8 hours and amikacin 1000mg intravenously
every 24 hours in the medical ward. Table 1 provides an example of administered doses
for this patient documented in eMAR. Table 2 illustrates the calculation of meropenem
and amikacin days by drug-specific (total) and stratified by route of administration based
upon the administered doses of meropenem and amikacin documented in eMAR. Table 3
illustrates the contribution of this patient’s antimicrobial days to the aggregate monthly
report per patient-care location.
Table 1. Example eMAR for Patient housed in Medical Ward
Medical Ward
Monday
Tuesday
December 28
December 29
Meropenem 1gram
intravenously every 8
hours
Amikacin 1000mg
intravenously every 24
hours

Given: 2300

Given: 0700
Given: 1500
Given: 2300

Given: 2300

Given: 2300

Table 2. Example of calculation of antimicrobial days
Calculation
Monday
Tuesday
December 28
December 29

Wednesday
December 30
Given: 0700

Wednesday
December 30

Drug-specific
Antimicrobial Days (total)

Meropenem Days = 1
Amikacin Days = 1

Meropenem Days = 1
Amikacin Days = 1

Meropenem Days = 1
Amikacin Days = 0

Drug-specific
Antimicrobial Days by
Stratification of Route of
Administration

Meropenem Days
(IV) = 1
Amikacin Days
(IV) = 1

Meropenem Days
(IV) = 1
Amikacin Days
(IV) = 1

Meropenem Days
(IV) = 1
Amikacin Days
(IV) = 0

Table 3. Example of antimicrobial days per month per patient-care location
Month/
Antimicrobial
Drug-specific Antimicrobial Days
YearAgent
Location
Total
IV
IM
Digestive
December
Medical
Ward
December
Medical
Ward

January, 2012

Respiratory

Meropenem

3

3

0

0

0

Amikacin

2

2

0

0

0

11-13

Medication-associated Module
AUR

Example 2. Differences in Calculation for Patient-Care Location and Facility-WideInpatient for a Patient Transferred Between Patient-Care Locations
This example illustrates the calculation of antimicrobial days from a patient receiving
vancomycin 1gram every 8 hours that was transferred from the MICU to a medical ward
on December 1. Table 1 provides an example of doses documented in eMAR
administered to this patient in the MICU and medical ward. Table 2 illustrates the
calculation of vancomycin days by drug-specific (total) and stratified by route of
administration based upon the administered doses of vancomycin documented in eMAR.
Table 3 illustrates the contribution of this patient’s vancomycin days to the aggregate
monthly report per patient-care location and facility-wide-inpatient.
Table 1. Example eMAR for Patient transferred from MICU to Medical Ward on
December 1.
Tuesday
Tuesday
December 1
December 1
Location: MICU
Location: Medical Ward
Vancomycin 1gram
intravenously every 8 hours

Given: 0700

Given: 1500
Given: 2300

Table 2. Example of calculation of antimicrobial days for December 1
Calculation
Tuesday
Tuesday
December 1
December 1
Location: MICU
Location: Medical Ward
Drug-specific Antimicrobial
Days (total)
Drug-specific Antimicrobial
Days by Stratification of Route
of Administration

Vancomycin Days = 1

Vancomycin Days = 1

Vancomycin Days
(IV) = 1

Vancomycin Days
(IV) = 1

Table 3. Example of antimicrobial days per month per patient-care location and facilitywide inpatient contributed from December 1
Month/
Antimicrobial
Drug-specific Antimicrobial Days
YearAgent
Location
Total
IV
IM
Digestive
Respiratory
December
MICU
December
Medical
Ward
December
Facilitywideinpatient

January, 2012

Vancomycin

1

1

0

0

0

Vancomycin

1

1

0

0

0

Vancomycin

1

1

0

0

0

11-14

Medication-associated Module
AUR

Example 3. Calculation of Antimicrobial Days for a Patient-Care Location when a
Patient Admission extends over Two Different Months
This example illustrates the calculation of antimicrobial days from a patient receiving
ceftriaxone 1gram intravenously every 24 hours for two days in the surgical ward (but
spanning different months). Table 1 provides an example of administered doses for this
patient documented in eMAR. Table 2 illustrates the calculation of ceftriaxone days by
drug-specific (total) and stratification of route of administration based upon the
administered doses of ceftriaxone documented in eMAR. Table 3 illustrates the
contribution of this patient’s ceftriaxone days to the aggregate monthly report per patientcare location.
Table 1. Example eMAR for Patient housed in Surgical Ward
Thursday
Friday
December 31
January 1
Location: Surgical Ward
Location: Surgical Ward
Ceftriaxone gram
intravenously every 24
hours

Given: 0800

Given: 0800

Table 2. Example of calculation of antimicrobial days
Calculation
Thursday
December 31
Location: Surgical Ward
Drug-specific Antimicrobial
Days (total)
Drug-specific Antimicrobial
Days by Stratification of
Route of Administration

Friday
January 1
Location: Surgical Ward

Ceftriaxone Day = 1

Ceftriaxone Day = 1

Ceftriaxone Day
(IV) = 1

Ceftriaxone Day
(IV) = 1

Table 3. Example of antimicrobial days per month per patient-care location
Month/
Antimicrobial
Drug-specific Antimicrobial Days
YearAgent
Location
Total
IV
IM
Digestive
December/
Surgical
Ward
January/
Surgical
Ward

January, 2012

Respiratory

Ceftriaxone

1

1

0

0

0

Ceftriaxone

1

1

0

0

0

11-15