Form 57.145 LTC-AU Module

Form Approved

OMB No. 0920-0666

Exp. Date: 12/31/2026

Long Term Care Antimicrobial Use (LTC-AU) Module-

Electronic Upload Specification Tables

These data will be collected for each long term care facility resident then uploaded in an aggregate monthly electronic file transfer from the facility to NHSN via Clinical Document Architecture (CDA).

Table 1. CDA File Descriptors, Antimicrobial order and resident-level data elements These data elements will be transmitted with each month’s report.
Variable Name	Description of Variable/Value set
Year	Record the 4-digit year during which the data were collected.
Month	Record the 2-digit month during which the data were collected.
Facility ID	Unique identifier for the long-term care facility. Facility OID
Resident ID	Resident name/identifier
Resident Name: Last	Resident surname
Resident Name: First	Resident first name
Resident Name: Middle	Resident middle name
Gender Identity	Male, Female, Female-to-male transgender, Male-to-female transgender, Identifies as non-conforming, Other, Asked but unknown
Sex at Birth	M (Male) or F (Female); O (other)
Race	American Indian or Alaska Native Asian; Black or African American; Middle Eastern or North African; Native Hawaiian or Pacific Islander; White; Declined to respond; Unknown
Ethnicity	Hispanic or Latino; not Hispanic or Latino; Declined to respond; Unknown
Resident Date of Birth	YYYY/MM/DD
Date Admission to Facility	YYYY/MM/DD
Date of Discharge	YYYY/MM/DD
Discharge Disposition	Description of discharge location (e.g., Home, Another Facility, Hospital, Death)
Antimicrobial	RXNorm codes for antibiotics, antifungals, antivirals (See Table 2)
Antimicrobial Order Start Date	YYYY/MM/DD
Antimicrobial Order End Date	YYYY/MM/DD
Antimicrobial Administration	YYYY/MM/DD/HH/MM/SS
Route	Route of administration: Digestive tract, intravenous route, intramuscular route
Data source	Designates this file as containing data about antimicrobial orders or antimicrobial administrations
Language: (Specify)
Interpreter needed:	Yes No

Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS H21-8, Atlanta, GA 30333, ATTN:  PRA (0920-0666). CDC xx.xxx v1 release number

Table 2. List of Antimicrobials to be Extracted		This is the list of antimicrobials that will be accepted into NHSN as part of the antimicrobial use reporting. Complete list of accepted RxNorm codes is found in the NHSN IDM Workbook.
ACYCLOVIR	CEFUROXIME		MINOCYCLINE
AMOXICILLIN	CEPHALEXIN		MOLNUPIRAVIR
AMOXICILLIN/CLAVULANATE	CIPROFLOXACIN		MOXIFLOXACIN
AMPHOTERICIN B	CLARITHROMYCIN		NAFCILLIN
AMPHOTERICIN B LIPID COMPLEX	CLINDAMYCIN		NIRMATRELVIR
AMPHOTERICIN B LIPOSOMAL	DALBAVANCIN		NITROFURANTOIN
AMPICILLIN	DAPTOMYCIN		OFLOXACIN
AMPICILLIN/SULBACTAM	DICLOXACILLIN		OMADACYCLINE
ANIDULAFUNGIN	DOXYCYCLINE		ORITAVANCIN
AZITHROMYCIN	ERAVACYCLINE		OSELTAMIVIR
AZTREONAM	ERTAPENEM		OXACILLIN
BALOXAVIR MARBOXIL	ERYTHROMYCIN		PENICILLIN G
CASPOFUNGIN	FAMCICLOVIR		PENICILLIN V
CEFACLOR	FIDAXOMICIN		PERAMIVIR
CEFADROXIL	FLUCONAZOLE		PIPERACILLIN/TAZOBACTAM
CEFAZOLIN	FOSFOMYCIN		PLAZOMICIN
CEFDINIR	GANCICLOVIR SODIUM		POSACONAZOLE
CEFEPIME	GENTAMICIN		REMDESIVIR
CEFIDEROCOL	IMIPENEM/CILASTATIN		REZAFUNGIN
CEFIXIME	IMIPENEM/CILASTATIN/RELEBACTAM		SULBACTAM/DURLOBACTAM
CEFOTAXIME	ISAVUCONAZONIUM		SULFAMETHOXAZOLE/TRIMETHOPRIM
CEFOTETAN	ITRACONAZOLE		TEDIZOLID
CEFOXITIN	KETOCONAZOLE		TELAVANCIN
CEFPODOXIME	LEFAMULIN		TETRACYCLINE
CEFPROZIL	LETERMOVIR		TIGECYCLINE
CEFTAROLINE	LEVOFLOXACIN		TINIDAZOLE
CEFTAZIDIME	LINEZOLID		TOBRAMYCIN
CEFTAZIDIME/AVIBACTAM	MEROPENEM		VALACYCLOVIR
CEFTIBUTEN	MEROPENEM/VABORBACTAM		VALGANCICLOVIR
CEFTOLOZANE/TAZOBACTAM	METRONIDAZOLE		VANCOMYCIN
CEFTRIAXONE	MICAFUNGIN		VORICONAZOLE

CDC xx.xxx V1