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Antimicrobial Use and Resistance Module
AUR

Antimicrobial Use and Resistance (AUR) Module
Table of Contents
Introduction
1. Antimicrobial Use (AU) Option
Introduction
Requirements
Data Analyses
Appendix A. Table of Instructions: Antimicrobial Use
Appendix B. List of Antimicrobials
Appendix C. Example Calculations of Antimicrobial Days
2. Antimicrobial Resistance (AR) Option
Introduction
Requirements
Data Analyses
Appendix A. List of Microorganisms for Antimicrobial Resistance
Appendix B. SNOMED Codes to Identify Eligible Specimen Types
Appendix C. Technical and Isolate Based Report Variables
Appendix D. Denominator Data Variables

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Introduction
This module contains two options, one focused on antimicrobial usage and the second on
antimicrobial resistance. To participate in either option, facility personnel responsible for
reporting antimicrobial use (AU) or resistance (AR) data to the National Healthcare Safety
Network (NHSN) must coordinate with their laboratory and/or pharmacy information
software providers 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
Health Level (HL7) Clinical Document Architecture (CDA).7 Manual data entry is not
available for the AUR Module.
Purpose:
The goal of this National Healthcare Safety Network (NHSN) AUR Module is to provide a
mechanism for facilities to report and analyze antimicrobial use and/or resistance as part of
local or regional efforts to reduce antimicrobial resistant infections through antimicrobial
stewardship efforts or interruption of transmission of resistant pathogens at their facility6.

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1. Antimicrobial Use (AU) 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
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-location-month or facilitywide-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 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, facilitywide-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

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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-wide-inpatient
(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)].

Inpatient Pediatric Wards

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.
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)].

Step Down Units

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Inpatient Locations
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)
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)

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). See Locations chapter for
more information regarding location mapping.
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, facilitywide-inpatient, and select outpatient acute-care settings (e.g., outpatient emergency
department, pediatric emergency department, 24-hour observation area) for select
antimicrobial agents and stratified by route of administration (e.g., intravenous,
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intramuscular, digestive and respiratory). Refer to Table 2 and Table 3 for definitions of
drug-specific 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
a
Route of Administration
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 PHIN
VADS
Table 3. Example Stratification of Antimicrobial Days by Route of Administration
Month/
YearLocation
MonthYear/
Location

Antimicrobial
Agent
Tobramycin

Drug-specific Antimicrobial Days
Total a

Digestiveb

Respiratory

Tobramycin
Days
(Total)

Tobramycin
Days
(IV)

Tobramycin
Days
(IM)

Tobramycin
Days
(Digestive)

Tobramycin
Days
(Respiratory)

Drug-specific antimicrobial days (total) attributes one antimicrobial day for any route 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 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-wideinpatient.
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

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patient transferred from the 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
Comments
Inpatient Care Location-Specific Analyses
Antimicrobial
Drug-specific antimicrobial days per One patient can contribute only
Days/Days
patient-care location per
one day present per calendar
present
month/Days present per patient-care day for each specific location.
location per month
Summed total may be higher
when compared to facilitywide measure (reflecting
transfers between locations).
Facility-wide-inpatient Analyses
Antimicrobial
Drug-specific antimicrobial days for One patient can contribute only
Days/Days
a facility per month/Days present
one day present per calendar
present
per facility-wide-inpatient per month 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.
Antimicrobial
Drug-specific antimicrobial days for Only calculated for facilityDays/Admissions a facility per month/Admissions per wide-inpatient for AU Option.
facility-wide-inpatient per month

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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 facilitywide-inpatient.

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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;157-1689-94.
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. http://www.cdc.gov/nhsn/CDA/index.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.

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

Numerator:

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 per Antimicrobial days are defined as the aggregate sum of the days of exposure for
month per location
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.
Denominator:
Required.
Days present

Admissions

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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 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
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 AUR Use Option, admissions are only
reported for facility-wide-inpatient.

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Appendix B. List of Antimicrobials
Please note that mapping of standardized terminology (RXNORM) are provided PHIN
Vocabulary Access and Distribution System (VADS).
Antimicrobial Agent
AMANTADINE

Antimicrobial
Category
Anti-influenza

Antimicrobial
Classa
M2 ion channel inhibitors

AMIKACIN

Antibacterial

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

Cephalosporin 5th generation

CEFTAZIDIME

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFTIBUTEN

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFTIZOXIME

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

CEFTRIAXONE

Antibacterial

Cephalosporins

Cephalosporin 3rd generation

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Antimicrobial Agent
CEFUROXIME

Antimicrobial
Category
Antibacterial

Antimicrobial
Classa
Cephalosporins

Antimicrobial
Subclassa
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
FIDAXOMICIN

Antibacterial
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 inhibitors

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Antimicrobial Agent
OXACILLIN

Antimicrobial
Category
Antibacterial

Antimicrobial
Classa
Penicillins

PENICILLIN G

Antibacterial

Penicillins

Antimicrobial
Subclassa
Penicillinase-stable
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

M2 ion channel inhibitors

SULFAMETHOXAZOLE/
TRIMETHOPRIM
SULFISOXAZOLE

Antibacterial

Folate pathway inhibitors

Antibacterial

Folate pathway inhibitors

TELAVANCIN

Antibacterial

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

Adapted from CLSI January 2010

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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

Given: 2300

Given: 0700
Given: 1500
Given: 2300

Amikacin 1000mg
intravenously every 24 hours

Given: 2300

Table 2. Example of calculation of antimicrobial days
Calculation
Monday
Tuesday
December 28
December 29
Drug-specific Antimicrobial
Days (total)
Drug-specific Antimicrobial
Days by Stratification of
Route of Administration

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

Wednesday
December 30
Given: 0700

Wednesday
December 30
Meropenem Days = 1
Amikacin Days = 0
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
Respiratory
December
Medical Ward
December
Medical Ward

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Meropenem

Amikacin

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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 patientcare 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 1Location:
Location: MICU
Medical Ward
Drug-specific Antimicrobial
Days (total)
Drug-specific Antimicrobial
Days by Stratification of Route
of Administration

Vancomycin Days = 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
Facility-wideinpatient

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Vancomycin

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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

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
(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

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Respiratory

Ceftriaxone

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2. Antimicrobial Resistance (AR) Option
Introduction
Common measures of antimicrobial resistance include the proportion of isolates resistant to
specific antimicrobial agents. This proportion resistant (%R) is used to aid in clinical
decision making (hospital antibiograms) as well as for assessing impact of cross
transmission prevention success or antimicrobial stewardship success, although the
measure may not be very sensitive to measuring success of efforts in the short term. An
additional value of measuring the proportion resistant includes a local or regional
assessment of progression or improvement of a particular resistance problem, to guide local
or regional cross-transmission prevention efforts. By utilizing standard methodology of
aggregating proportion resistant, better local and regional assessments of the magnitude of
a particular resistance phenotype will be more valid.
Objectives:
1. Facilitate evaluation of antimicrobial resistance data using a standardized approach
to
a. Provide local practitioners with an improved awareness of a variety of
antimicrobial-resistance problems to both aid in clinical decision making
and prioritize transmission prevention efforts
b. Provide facility-specific measures in context of a regional and national
perspective (i.e., benchmarking) which can inform decisions to accelerate
transmission prevention efforts and reverse propagation of emerging or
established problematic resistant pathogens.
2. Regional and national assessment of resistance of antimicrobial resistant pathogens
of public health importance including ecologic assessments and infection burden
Methodology:
Antimicrobial resistance data are reported as a proportion and rate in this module.8 The
proportion resistant is defined as the number of resistant isolates divided by the number of
isolates tested for the specific antimicrobial agent being evaluated. In comparison, the
antimicrobial resistance rate is defined as the number of resistant isolates per 1000 patient
days. For each facility, the numerator (i.e., number of resistant isolates) is derived from
isolate-level reports submitted. The denominator is reported directly (i.e., not derived
from other reports). The numerator and denominator are further defined below and must
adhere to the data format prescribed by the HL7 CDA Implementation Guide developed by
the CDC and HL7.7
Settings:
NHSN requires reports to cover all NHSN-defined inpatient locations and select outpatient
acute-care settings (i.e., outpatient emergency department, pediatric emergency department,
24-hour observation area) at each facility. Eligible facilities include acute care facilities
including long-term acute care and inpatient rehabilitation facilities.

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Requirements:
Each month,
1. The facility must choose to monitor antimicrobial resistance data on the Patient
Safety Monthly Reporting Plan (CDC 57.106)
2. Two record types must be reported for each month of surveillance.
• One for the isolate-based reports
• One for the denominator data report (facility-wide).
Isolate-based report
Report all required data each month for each eligible Isolate-based report. Eligible Isolatebased reports must have had susceptibility testing performed. Two distinct events should be
reported. (See Appendix A)
1. First eligible pathogen isolated from blood culture per patient, per 14 day period
even across calendar months (i.e., report all unique blood specimens).
2. First eligible pathogen isolated from any eligible non-blood culture source, per
patient, per month. This should be consistent with CLSI M39 Guidance on
reporting cumulative susceptibility test results.
A. Eligible pathogens include:
• Acinetobacter baumannii (ACBA)
• Candida albicans (CA)
• Candida glabrata (CG)
• Citrobacter freundii (CF)
• Enterobacter spp.(ESP)
• Enterococcus faecalis (ENTFS)
• Enterococcus faecium, (ENTFM)
• Enterococcus spp. NOS (not otherwise specified to the species level) (ENTSP)
• Escherichia coli (EC)
• Group B Streptococcus (GBS)
• Klebsiella oxytoca (KO)
• Klebsiella pneumoniae (KP)
• Morganella morganii (MM)
• Proteus mirabilis (PM)
• Pseudomonas aeruginosa (PA)
• Serratia marcescens (SM)
• Staphylococcus aureus (SA)
• Stenotrophomonas maltophilia (STEMA)
• Streptococcus pneumoniae (SP)

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B. Specimen Sources
• Eligible non-blood culture source (one per patient, per month) include:
o Lower respiratory (e.g., sputum, endotracheal, bronchoalveolar lavage)
o Urine
o Cerebral spinal fluid
•

Unique Blood Specimen:
o Report blood cultures growing same eligible pathogen with no intervening
positive blood culture (with same eligible pathogen) within 14 days.
 In a patient who already has a blood culture isolate-based report for
a specific organism, report an additional Isolate-based report from an
additional blood culture only if there is no prior positive blood
culture for the same genus/species within 14 days, even across
calendar months.
 There should be a full 14 days with no positive blood culture result
with the same genus/species from the same patient before another
Unique Blood Specimen is reported. (e.g., there should be >14 days
since previous isolation)

Use SNOMED codes to identify eligible specimen types to be included in identification of
Isolate-based report. (Appendix B)
C. Required data includes mostly data available from the laboratory information system
and some from administrative data systems. The set of variables for each isolate
consists of a technical variable, healthcare facility identifier and epidemiological
variables which are further classified into variables at isolate level and variables at
antimicrobial test level. The first level includes data referring to the isolate which are
repeated in all records reporting the antimicrobial susceptibility tests performed for that
isolate (See Appendix C).
• Isolate / Patient related data
o Patient identifier
o Date of Birth
o Gender
o Date admitted to hospital
o Specimen Collection Date
o Specimen source (SNOMED)
o Location code – (mapped to CDC location codes)
o Isolate identifier (unique isolate ID)
o Pathogen (Appendix A)
•

Antimicrobial susceptibility data
o Antibiotic (Appendix A)
o PBP2a-agglutination (only if STAAUR)

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o
o
o
o
o
o
o
o
o
o
o
•

PCR mec-gene (only if STAAUR)
E-test sign
E-test value
Interpretation of E-test
MIC sign
MIC value
Interpretation of MIC test
Zone sign
Zone value
Interpretation of zone test (disk diffusion)
Final interpretation result

Technical variable
o Facility ID (facility identifier, unique to NHSN)

D. Remove Duplicates
The goal of this option to capture the first isolate per patient per month from non-blood
culture source and in addition, every unique blood isolate per patient per month
(maximum of 3 per month per patient). However, often multiple isolates of the same
species are processed on the same day, often with conflicting results. Only one isolate
should be chosen, retaining the unique nature of the test results. Rules must be in place
to ensure duplicate isolate reports are removed. Duplicates are defined as same species
or same genus when identification to species level is not provided from same patient on
same day. Identify observations reflecting multiple isolates within the same day (i.e.,
using the field Isolate ID when available) and select the isolate to report to NHSN
based on these rules:
• Eliminate isolates on same day without susceptibility test results
• On a single isolate if no final interpretation, prioritize test results for “E-test
interpretation> MIC interpretation > Zone Interpretation”
• On a single isolate, when multiple results per antimicrobial (for a single test
method), choose the most resistant result for each antimicrobial
• Do not merge test results across multiple isolates (i.e., don’t summarize results
across different isolates tested on same day)
• If testing results are indistinguishable, choose isolate test with more complete
fields for other variables
• Interpretation of test results (E-test, MIC test, Zone test) includes the following
results S=Susceptible, S-DD – Susceptible-Dose Dependent, I =Intermediate,
R=Resistant NS = Non-Susceptible, N = Not Tested
Examples should reflect the above rules:
• Example 1: two different tests on same date are performed, producing conflicting
SIR interpretations. Results should be merged into a single observation, with the
“Final interpretation” variable being populated by the final determination of the
laboratory.
• Example 2: Same test but conflicting results. Report most resistant (i.e., R > I > S).
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•

Example 3: Same test and same results. Report result with most complete fields for
other variables.

Denominator data report
For each month, report facility-wide denominator data (See Appendix D)
1. Patient Days: Number of patients present in the hospital at the same time period on
each day of the month, summed across all days in the month
2. Admissions: Number of patients admitted to the hospital each month
3. Number of blood cultures performed, each month (for all locations included in the
reporting plan).
For further information on counting patient days and admissions
http://www.cdc.gov/nhsn/PDFs/PatientDay_SumData_Guide.pdf.
Minimizing Bias
Source of test results should be from the hospital laboratory-information system (LIS).
However, efforts should be made to reduce selection bias inherent in systems that have
suppression rules in place preventing testing results from being placed into the LIS. Efforts
should be made to optimize suppression rules so resistant results are not suppressed (i.e.
only suppress susceptible results of candidates to be suppressed). Alternatively, allow
transmission of suppressed results to LIS but construct LIS-based selective suppression of
reports to clinicians (but not laboratorians).
Data Analyses:
Antimicrobial resistance data will be expressed using several metrics, likely at quarterly,
semi-annual, or annual time frame depending on how rare the isolates occurred. (See Table
1)

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Table 1. Proposed Resistance Metrics
Metric
Definition
Comments
Facility-wide-inpatient: standard output for facility and group user.
% non-susceptible (# Resistant + # Intermediate/ #
Custom output can include
tested)
stratification by specimen
source; blood, urine, other;
Drug-specific antimicrobial
resistance for a facility /Number
helpful for empiric prescribing
for suspected pathogen. Report
of isolates tested per facility for
specific microorganismnon-susceptible since many
organisms lack resistant
antimicrobial pairing
breakpoint to specific drugs,
reporting would be similar to,
EARS-Net and more closely
represents clinical care setting.
BSI % non(# Resistant BSI + # Intermediate Most comparable to EARSsusceptible
BSI/# tested)
net. If patient identifiers are
Drug-specific antimicrobial
retained, this can be deresistance among positive blood
duplicated to be fully
cultures for a facility/Number of
comparable with EARS-Net
isolates from blood cultures tested with a 1 patient/year measure.
per facility for specific
microorganism-antimicrobial
pairing
Hospital- onset
Drug-specific antimicrobial
Focuses on incident cultures,
antimicrobial
resistance (i.e., # non-susceptible) proxy for transmission within a
resistance rate
among isolates collected >3 days hospital or exogenous
after admission, for a
acquisition. May be good
facility/1000 patient-days
outcome for stewardship
BSI resistance
Drug-specific antimicrobial
Overall good measure of
incidence
resistance (i.e., # non-susceptible) community and hospital-based
(stratified by
unique blood culture positive tests occurrence, estimates crude
timing of onset)
/100 admissions. Evaluate by
burden, can be split by crude
timing of blood culture (hospital
hospital onset and crude
onset vs. present on admission)
community onset

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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;157-1689-94.
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. http://www.cdc.gov/nhsn/CDA/index.html
8. Schwaber MJ, De-Medina T, and Carmeli Y. Epidemiological interpretation on
antibiotic resistance studies – what are we missing? Nat Rev Microbiol
2004;2:979-83.
9. CLSI. Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test
Data; Approved Guideline – Third Edition. CLSI document M39-A3. Wayne, PA:
Clinical and Laboratory Standards; 2009.
10. CLSI. Reference Method for Broth Dilution Antifungal Susceptibility Testing of
Yeasts; Third Informational Supplement. CLSI document M27-S3. Wayne, PA:
Clinical and Laboratory Standards Institute; 2008.

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11. CLSI. Performance Standards for Antimicrobial Susceptibility Testing; TwentyFirst Informational Supplement. CLSI document M100-S21. Wayne, PA: Clinical
and Laboratory Standards Institute; 2011.
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.

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Appendix A. List of Microorganisms for Antimicrobial Resistance9
Please note that mapping of standardized terminology (SNOMED) are provided via the haivoc spreadsheet.

Micro-organism
Acinetobacter baumannii

Candida albicans
Candida glabrata

Citrobacter freundii
Enterobacter spp.
Escherichia coli
Klebsiella oxytoca
Klebsiella pneumoniae
Morganella morganii

February 2013

Specimen Type
Blood, Urine, Lower
Respiratory, CSF

Additional Agents for Urine
Blood, Urine,
CSF
[Lower respiratory will not
be collected for Candida
spp.],

Additional Agents for Urine
Blood, Urine, Lower
Respiratory, CSF

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Antimicrobial Agents
Ampicillin-sulbactam
Ceftazidime
Ciprofloxacin
Levofloxacin
Imipenem
Meropenem
Gentamicin
Tobramycin
Amikacin
Piperacillin-tazobactam
Ticarcillin-clavulanate
Cefepime
Cefotaxime
Ceftriaxone
Doxcycline
Minocycline
Tetracycline
Piperacillin
Trimethoprimsulfamethoxazole
None
Anidulafungin
Caspofungin
Fluconazole
Flucytosine
Itraconazole
Micafungin
Posaconazole
Voriconazole
None
Ampicillin
Cefazolin
Gentamicin
Tobramycin
Amikacin
Amoxicillin-clavulanic acid

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Micro-organism
Proteus mirabilis
Serratia marcescens

Specimen Type

Additional Agents for Urine

Enterococcus faecalis
Enterococcus faecium
Enterococcus spp. NOS
(not otherwise specified)
(excluding E. faecalis and
E. faecium, and excluding
other identified species)

Blood, Urine, Lower
Respiratory, CSF

Antimicrobial Agents
Ampicillin-sulbactam
Piperacillin-tazobactam
Ticarcillin-clavulanic acid
Cefuroxime
Cefepime
Cefoxitin
Cefotaxime
Ceftriaxone
Ciprofloxacin
Levofloxacin
Doripenem
Ertapenem
Imipenem
Meropenem
Piperacillin
Trimethoprimsulfamethoxazole
Aztreonam
Ceftazidime
Chloramphenicol
Tetracycline
Cephalothin
Lomefloxacin
Ofloxacin
Norfloxacin
Nitrofurantoin
Sulfisoxazole
Trimethoprim
Ampicillin
Penicillin
Daptomycin
Linezolid
Quinupristin/dalfopristin
Vancomycin
High-level Resistance Screen
for Gentamicin and
Streptomycin (non-urine
isolates only); synergistic test
result will be reported as
susceptible; non-synergistic
test result will be reported as
resistant.

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Micro-organism

Specimen Type
Additional Agents for Urine

Pseudomonas aeruginosa

Blood, Urine, Lower
Respiratory, CSF

Additional Agents for Urine

Staphylococcus aureus

February 2013

Blood, Urine, Lower
Respiratory, CSF

11-27

Antimicrobial Agents
Ciprofloxacin
Levofloxacin
Norfloxacin
Nitrofurantoin
Tetracycline
Ceftazidime
Gentamicin
Tobramycin
Piperacillin
Amikacin
Aztreonam
Cefepime
Ciprofloxacin
Levofloxacin
Imipenem
Meropenem
Piperacillin-tazobactam
Ticarcillin
Lomefloxacin
Ofloxacin
Norfloxacin
Azithromycin
Clarithromycin
Erythromycin
Clindamycin
Oxacillin
Cefoxitin
Penicillin
Trimethoprimsulfamethoxazole
Daptomycin
Linezolid
Telithromycin
Doxycycline
Minocycline
Tetracycline
Vancomycin
Rifampin
Chloramphenicol
Ciprofloxacin
Levofloxacin
Ofloxacin
Moxifloxacin

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Micro-organism

Specimen Type

Additional Agents for Urine

Stenotrophomonas
maltophilia

Blood, Urine, Lower
Respiratory, CSF

Additional Agents for Urine
Streptococcus pneumoniae Blood, Urine, Lower
Respiratory, CSF

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Antimicrobial Agents
Gentamicin
Quinupristin-dalfoprisin
Lomefloxacin
Norfloxacin
Nitrofurantoin
Sulfisoxazole
Trimethoprim
Trimethoprimsulfamethoxazole
Ceftazidime
Chloramphenicol
Levofloxacin
Minocycline
Ticarcillin-clavulanate
None
Erythromycin
azithromycin
Penicillin (meningitis
breakpoint)
Penicllin (non-meningitis
breakpoint)
Penicillin V (oral breakpoint)
Trimethoprimsulfamethoxazole
Cefepime,
Cefotaxime (meningitis
breakpoint)
Cefotaxime (non-meningitis
breakpoint)
Ceftriaxone(meningitis
breakpoint)
Ceftriaxone (non-meningitis
breakpoint)
Clindamycin
Gemifloxacin
Levofloxacin
Moxifloxacin
Ofloxacin
Meropenem
Telithromycin
Tetracycline
Vancomycin
Amoxicillin

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Micro-organism

Specimen Type

Group B Streptococcus

Additional Agents for Urine
Blood, Urine, Lower
Respiratory, CSF

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Antimicrobial Agents
Amoxicillin-clavulanic acid
Cefuroxime
Chloramphenicol
Ertapenem
Imipenem
Linezolid
Rifampin
None
Clindamycin
Erythromycin
Cefotaxime
Cefazolin
Cefoxitin
Ampicillin
Penicillin
Levofloxacin
Ciprofloxacin
Tetracycline
Vancomycin
Daptomycin
Linezolid

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Appendix B. SNOMED Codes to Identify Eligible Specimen Types
a
Mapping of standardized terminology for specimen type are provided via the hai-voc
spreadsheet
Specimen
Type
Blood
Urine
Cerebral
Spinal Fluid
Lower
Respiratory
Specimens

February 2013

Descriptiona
Blood specimen (specimen)
Urinary specimen (specimen)
Cerebrospinal fluid sample (specimen)
coughed sputum specimen (specimen)
specimen from trachea (specimen)
specimen from lung obtained by bronchial washing
procedure (specimen)
specimen from lung obtained by biopsy (specimen)
specimen from lung obtained by fiberoptic bronchoscopic
biopsy (specimen)
upper respiratory fluid specimen obtained by tracheal
aspiration (specimen)
tissue specimen from bronchus (specimen)
tissue specimen from trachea (specimen)
bronchial fluid sample (specimen)
sputum specimen obtained by aspiration (specimen)
sputum specimen obtained by aspiration from trachea
(specimen)
sputum specimen obtained by sputum induction (specimen)
sputum specimen obtained from sputum suction trap
(specimen)
lower respiratory tissue sample (specimen)
lower respiratory fluid sample (specimen)
transbronchial lung biopsy sample (specimen)
bronchial biopsy sample (specimen)
bronchial brushings sample (specimen)
tissue specimen from lung (specimen)
specimen obtained by bronchial aspiration (specimen)
specimen obtained by bronchioloalveolar lavage procedure
(specimen)
specimen from trachea obtained by aspiration (specimen)
specimen obtained by bronchial trap (specimen)
bronchial fluid specimen obtained from bronchial trap
(specimen)
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SNOMED
CT Code
119297000
122575003
258450006
119335007
119390000
122609004
122610009
122611008
122877000
128158009
128173005
258446004
258608003
258609006
258610001
258611002
309170008
309171007
309173005
309174004
309176002
399492000
441903006
441917002
445447003
446838005
447345009

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Specimen
Type

Descriptiona
sputum specimen (specimen)
specimen from bronchus (specimen)
specimen from lung (specimen)
lower respiratory sample (specimen)
bronchoalveolar lavage fluid sample (specimen)
tracheal biopsy sample (specimen)

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SNOMED
CT Code
119334006
119391001
127458004
258606004
258607008
309169007

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Appendix C. Technical and Isolate Based Report Variables
NAME

DESCRIPTION OF FIELD

Facility ID

NHSN-assigned facility ID number

Patient ID

Alphanumeric patient ID assigned by
the hospital and may consist of any
combination of numbers and/or
letters. This should be an ID that
remains the same for the patient
across all visits and admissions.
The date of the patient’s birth
including month, day , year
M (Male), F (Female), O (Other) to
indicate the gender of the patient
Date patient was admitted to an
inpatient acute care facility Including
month, day ,year If the laboratory
specimen is reported from an
outpatient location enter a null value
Date the specimen was collected
including month, day, year
Specimen source from which the
isolate was recovered (e.g. urine,
lower respiratory, blood, CSF)
Patient care area where patient was
when the laboratory specimen was
collected
Isolate identifier unique for each
isolate within laboratory and year.
Pathogen identified from specimen
collected (Appendix A)

Date of Birth
Gender
Date admitted
to facility

Specimen
collection date
Specimen
source
Location

Isolate
identifier
Pathogen

Antibiotic

PBP2aagglutination
PCR mec-gene

E-test sign
E-test value

February 2013

Antibiotic(s) tested for susceptibility
(Appendix A will define agents by
pathogen and specimen source)
Result for PBP2a-agglutination (only
if SA) Pos/Neg/Unk
Result for PCR mec-gene (only if SA)
Pos/Neg/Unk
E-test sign (> < =).
E-test (Value in micrograms/liter).
Use '.' as decimal delimiter, e.g. 0.25

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CODE
VALUE LIST

LEVEL OF
REQUIREMENT

NHSN

Required
Required

Required
Required
Required

Required
(SNO MED)

Required

CDC Location
Codes

Required

Required
Pathogen
NHSN

Required

Conditional (for
Staph aureus)
Conditional (for
Staph aureus)
Conditional
Conditional

Antimicrobial Use and Resistance Module
AUR

NAME

DESCRIPTION OF FIELD

Interpretation
of E-test

Interpretation result of the E-test
susceptibility test performed

MIC sign
MIC value

MIC sign (> < =).
MIC (Value in micrograms/liter). Use
'.' as decimal delimiter, e.g. 0.25
Interpretation result of the MIC
susceptibility test performed
Zone sign (> < =).
Zone value in millimeters
Interpretation result of the zone
susceptibility test performed
Final interpretation result of all
different susceptibility tests
performed

Interpretation
of MIC test
Zone sign
Zone value
Interpretation
of Zone test
Final
Interpretation
result

February 2013

11-33

CODE
VALUE LIST

LEVEL OF
REQUIREMENT
Conditional
Conditional
Conditional
Conditional
Conditional
Conditional
Conditional
Required

Antimicrobial Use and Resistance Module
AUR

Appendix D. Denominator Data Variables
DESCRIPTION OF FIELD

CODE
VALUE LIST

LEVEL OF
REQUIREMENT

NHSN

Required

Facility Wide Denominator
Facility ID

NHSN –assigned facility ID number

Location

FacWideIN

Required

Month

2-Digit month

Required

Year

4-Digit year

Required

Patient
Days

For facility wide inpatient locations enter
the total number of patient days collected at
the same time each day combined for the
month. All of the facility’s inpatient
locations with an overnight stay should be
included where denominators can be
accurately collected.
For facility wide inpatients, enter the total
number of admissions for all facility
inpatient locations combined for the month.
All the facility’s inpatient locations with an
overnight stay should be included where
denominators can be accurately collected.
Number of blood cultures performed, each
month (for all inpatient locations included
in the reporting plan).

Required

Admission
Count

Blood
cultures
performed

February 2013

11-34

Required

File Type	application/pdf
Author	CDC User
File Modified	2013-04-18
File Created	2013-04-05