Emergency department antibiogram software for ED pharmacists and stewardship teams who treat and discharge
The hospital antibiogram is built mostly from inpatient isolates, yet the ED writes the oral prescription that most UTI and skin infection patients go home with. Here is what an emergency department antibiogram needs, how hospitals build one, and what software for it costs.
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Emergency department antibiogram software takes your lab's culture and susceptibility export, keeps only isolates collected in the ED, applies CLSI M39 rules and prints a table the ED can use for patients who leave with an oral antibiotic. Antimicrobe does this from a CSV file; the unit cut that isolates the ED is on the Stewardship plan at $749 a month.
This post is for the emergency medicine pharmacist, the stewardship pharmacist who supports the ED, and the ED medical director who has been told to "use the antibiogram" when the antibiogram on the intranet was built for the inpatient floors.
Why the hospital antibiogram is the wrong table for the ED
A hospital-wide antibiogram counts the first isolate of each species per patient across every unit. Inpatients, especially ICU patients and long stays, have usually met more antibiotics and carry more resistant organisms. Their isolates pull the percentages down for drugs the ED relies on, and the ED may reach for a broader agent than its own patients need.
The opposite error happens too. A patient discharged home with cellulitis or a lower urinary tract infection gets one oral drug and no follow-up culture. If the house-wide number flatters that drug, the failure shows up as a return visit rather than as a resistant isolate on the next report.
The best published example of the gap comes from the Children's Hospital of Philadelphia. Simpao and colleagues (Applied Clinical Informatics, 2018) built an electronic antibiogram with separate views for emergency, inpatient and outpatient isolates, close to 4,000 of them from the ED. They found that 90 percent of MRSA wound isolates from the ED were susceptible to clindamycin against 79 percent hospital-wide, and that among ED patients discharged home the clindamycin rate ran at least 10 points above the cumulative MRSA figure. That is a different oral prescribing decision.
What an emergency department antibiogram needs
CLSI M39 describes stratifying cumulative data by unit, with the emergency department named as an example, and by specimen source. An ED antibiogram that prescribers will trust usually has these parts.
The counting rules are the same ones described on CLSI M39 antibiogram software. The urinary piece on its own is covered on UTI antibiotic resistance in your own isolates.
- ED isolates only. Cultures whose collection location is the emergency department, ideally split into patients discharged home and patients admitted
- Urine apart from everything else. Most ED cultures are urine, and urinary E. coli behaves differently from blood or wound E. coli
- Wound and skin as its own table. That is where the MRSA and clindamycin or doxycycline decision lives
- First isolate per patient in the period, so frequent visitors do not count five times
- No percentage on fewer than 30 isolates, with pooled years labeled when the ED is too small for one year
- The oral drugs the ED actually prescribes. Nitrofurantoin, trimethoprim-sulfamethoxazole, cephalexin, ciprofloxacin, doxycycline and clindamycin belong on the page even when the inpatient report leads with IV agents
How hospitals build an ED antibiogram today
| Route | How the ED cut is made | Who does the work | What it costs |
|---|---|---|---|
| Excel from an LIS export | Filter the location column to the ED, rebuild the pivot tables | Stewardship pharmacist or lab lead, every year | Staff hours |
| Instrument data manager | Location filter if the instrument carries the location, often it does not | Microbiology lab | Included with the instrument |
| EHR analytics build | A dashboard on the reporting database, as CHOP did with QlikView on Epic Clarity | Analytics team plus stewardship | Weeks of analyst time, then upkeep |
| Enterprise surveillance platform | Antibiogram views inside a platform bought for alerts and NHSN reporting | Vendor build plus pharmacy | Unpublished, enterprise contract |
| Antimicrobe | Unit cut on the location column, source cut for urine and wound | Whoever uploads the export | $749 a month (Stewardship) |
Can our LIS export show which cultures came from the ED?
Usually yes. Almost every LIS stores the ordering location or patient location at collection, and that column is what an ED antibiogram is built on. Ask for it to be added to the yearly susceptibility export next to patient identifier, collection date, specimen source, organism, drug and interpretation.
Two details matter. Some hospitals record the location at result time rather than collection, so a patient admitted from the ED shows up under the admitting floor. And some instruments drop location entirely. If either happens, the export from the LIS rather than the instrument is the better source, and Antimicrobe lets you map location names once, so "ED", "EMER" and "Main ED" become one unit.
The full list of columns is on laboratory information system exports.
How much does emergency department antibiogram software cost?
With Antimicrobe, an ED antibiogram needs the unit cut, which is on the Stewardship plan at $749 a month for up to three facilities, 150,000 isolates a year and eight seats. It also carries syndrome grouping, quarterly trends and MDRO threshold alerts. Annual billing is half the monthly price. The Lab plan at $249 cuts by source and period, which gives you urine and wound tables for the whole hospital but not an ED-only view.
The other routes cost staff time rather than a license. An Excel rebuild is cheap until the person who knows the spreadsheet leaves. An EHR analytics dashboard is the most flexible and the most expensive in analyst weeks. Enterprise surveillance platforms do not publish prices.
If the ED antibiogram is one item on a wider shortlist of antimicrobial stewardship software, the platforms are compared there. Every limit is on the pricing page, and the full comparison of routes is in how much antibiogram software costs.
Do urgent care and freestanding EDs need their own antibiogram?
They benefit from one, and CDC's Core Elements of Outpatient Antibiotic Stewardship apply to emergency departments and urgent care as well as clinics. A freestanding ED or an urgent care group whose cultures go to the hospital lab can be cut as its own location. When a site is too small to reach 30 isolates, pool it with the main ED and label the table, or pool two years.
Clinic and urgent care reports are covered on outpatient antibiogram software, and children's EDs, where weight-based dosing and different organisms change the table, on pediatric antibiogram software.
Putting the ED antibiogram in front of prescribers
A table nobody opens changes nothing. EDs that use their antibiogram well tend to fold it into the discharge order sets for UTI and skin infection, print a pocket card for residents, and review it with the ED pharmacist once a year when the new data lands.
The antibiogram tells prescribers which drug is likely to work locally. Questions about duration and whether a shorter course is safe are a separate evidence question, and teams that want the trial data behind a five-day course for uncomplicated cellulitis can look it up with a tool that answers clinical questions from published trials. The empiric ranking by source and unit that sits under every Antimicrobe table is explained on empiric antibiotic therapy by your antibiogram, and syndrome grouping on syndromic antibiogram software.
Questions to ask before choosing ED antibiogram software
- Does it cut by collection location, and can it merge different spellings of the ED into one unit?
- Can it split ED urine from ED wound and ED blood in the same run?
- Does it apply the first isolate rule before the unit cut, as CLSI M39 describes?
- How does it show cells under 30 isolates and pooled years?
- Does it show the oral agents the ED prescribes, not only the IV panel?
- Can the ED pharmacist produce next year's table without the analyst who built this one?
- Is the price published, and which plan carries the unit cut?
Related on this site: syndromic antibiogram software, outpatient antibiogram software, UTI antibiotic resistance in your own isolates, how much antibiogram software costs, Antimicrobe pricing.