Critical access hospitals
Critical access hospital antibiogram software, a small hospital antibiogram and rural hospital antibiogram built from your own cultures
A 25-bed hospital might grow 150 E. coli a year and a dozen Pseudomonas. That is enough for a useful antibiogram if the report is honest about its denominators, and nowhere near enough to copy the format a 500-bed hospital uses.
Try the builder on the sample data, or drop in your own CSV. It is parsed in your browser and never uploaded.
Short answer
A critical access hospital antibiogram is a cumulative susceptibility report built from the hospital's own culture results, usually pooled across two or three years because one year rarely gives 30 isolates of anything but E. coli. Antimicrobe builds it from the CSV your in-house lab or reference lab already produces, keeps the first isolate per patient per organism, suppresses any cell under 30 isolates, and prints the count behind every percentage. The Lab plan is $249 a month, bought by card, with no interface to build.
Why most critical access hospitals still do not have a usable antibiogram
The problem is rarely that nobody cares. It is that the antibiogram lands on a pharmacy director who is also the stewardship lead, the formulary manager and often the only pharmacist on nights, and the data sits somewhere awkward: an instrument data manager in a two-person lab, a reference lab portal, or a parent system's LIS the hospital cannot query itself.
The second problem is volume. CLSI M39 says a percent susceptible should rest on at least 30 isolates. A critical access hospital, which CMS caps at 25 inpatient beds, hits that for E. coli and sometimes Klebsiella in a year. Everything else either gets pooled over several years, reported as a count, or left off. Hand-built spreadsheets tend to do none of those three things consistently, and prescribers learn to ignore the result.
- Isolates sit in an instrument data manager, a reference lab report or a parent system LIS, not in one file
- Most organisms fall under the 30-isolate floor in any single year
- Duplicate cultures from the same patient inflate resistance in a small denominator faster than in a large one
- The person building it has no analyst and no time to learn WHONET on a Windows machine
What CMS and CDC actually expect from a CAH antibiogram
The CMS condition of participation for critical access hospitals, 42 CFR 485.640, requires an infection prevention and control program and an antibiotic stewardship program with a qualified leader, documented activities and reporting to the medical staff and governing body. It does not use the word antibiogram. Surveyors look for evidence that stewardship decisions are based on data, and a current local or regional antibiogram is the most common piece of that evidence.
CDC's guidance on implementing the core elements in small and critical access hospitals is more direct. It says treatment decisions should ideally be driven by local data on antibiotic resistance, and that if local antibiograms are unavailable, hospitals should consider regional resistance data. It also notes that many critical access hospitals adapt treatment recommendations from nearby hospitals or collaboratives. Both routes work. The local report is better when you can make it honest, because your community's urinary E. coli is not the university hospital's.
Small hospital antibiogram options, by how many isolates they rest on
Most small hospitals end up with a combination: a pooled local report for urine and the organisms they grow often, and a regional reference for the rest, with both named on the same page so a prescriber knows which number is which.
| Option | What it rests on | What prescribers get | When to use it |
|---|---|---|---|
| Single-year facility report | One year of first isolates | Reliable %S for E. coli, often little else | Only if your lab grows several hundred isolates a year |
| Pooled 2 to 3 year facility report | Two or three years of first isolates, window printed on the report | %S for the common Gram negatives and S. aureus, counts for the rest | The default for most critical access hospitals |
| Facility plus affiliated sites | Your hospital, its clinic and an attached nursing home pooled or compared | A community-level picture with each site still visible | When the same physicians cover all three settings |
| Regional or state antibiogram | Other hospitals' isolates, often published yearly | Broad %S for most organisms, not your patients | As a fallback for organisms you cannot report locally |
Where a critical access hospital's susceptibility data actually lives
Before buying anything, find the export. Hospitals with an in-house micro bench usually run a VITEK 2, BD Phoenix or MicroScan panel, and the instrument's data manager or the LIS can write a line list of isolates with the organism, specimen source, collection date, patient identifier and an S, I or R per drug. Hospitals that send cultures out get the same data from the reference lab, often as a monthly report or a portal download, and most reference labs will produce a CSV line list on request.
Many critical access hospitals run MEDITECH, where the antibiogram usually depends on someone writing a Data Repository query; what that involves is covered in antibiogram software for MEDITECH hospitals, linked below. Many others run TruBridge EHR, formerly CPSI, whose lab system holds culture and sensitivity results but publishes no ready-made M39 report; the export is covered on CPSI EHR antibiogram software, also linked below.
Hospitals that belong to a larger system are sometimes told the system builds the antibiogram. Ask whether it is cut for your facility. A system-wide report pooled from a 400-bed tertiary center tells your emergency department very little about the community it serves.
- In-house lab: instrument data manager or LIS line list export
- Reference lab: monthly susceptibility line list, requested as CSV
- Parent system LIS: a facility-filtered extract from the system lab team
- Any of the above: the patient identifier is hashed on upload and never stored, because the first-isolate rule only needs a consistent key
How it works for a 25-bed hospital
The builder at the top of this page runs the same rules on sample data, so you can check how a suppressed cell and an isolate count look before you buy.
- Upload one CSV, or several years of them. Common export headings (patient or MRN, organism, antibiotic, result) are recognized automatically
- The engine keeps the first isolate per patient per organism inside the cut you choose, so repeat urine cultures do not skew a small denominator
- Cells under 30 isolates are suppressed and shown as counts, and the pooling window is printed on the report
- Cut by specimen source (urine versus everything else is the cut most small hospitals need), then print or export for the P and T or medical staff meeting
What it costs compared with the other routes
If you are still deciding what the stewardship program itself needs to buy, the antibiotic stewardship software guide for critical access hospitals covers the EHR modules, telestewardship and AUR reporting. The full plan list is on the pricing page.
| Route | License | Whose time it takes | Fit for a CAH |
|---|---|---|---|
| Excel by hand | None | The pharmacist, a few days a year, redone each year | Works until the person who built it leaves |
| WHONET | Free desktop app | Setup of BacLink to your export, Windows 10 or 11 only, one user | Capable, but the learning curve lands on one person |
| Enterprise surveillance platform | Quoted, implementation fee plus annual license | EHR interface build and a vendor project | Rarely sized or priced for a 25-bed hospital |
| Antimicrobe Lab | $249 a month, by card | One upload, occasionally a renamed column | One facility, 25,000 isolates a year, 2 seats |
| Antimicrobe Stewardship | $749 a month | Same | Up to 3 facilities (hospital, clinic, attached nursing home), unit and quarterly cuts, MDRO counts |
Swing beds, the clinic and the nursing home down the road
Many critical access hospitals run swing beds, a rural health clinic and sometimes an attached or affiliated nursing home, and the same handful of physicians prescribe in all of them. Pooling those isolates into one community antibiogram raises the counts, and keeping each site as its own column shows whether the nursing home's urinary E. coli behaves differently from the emergency department's.
The long-term care side has its own rules under F881, covered on the nursing home antibiogram page. Hospitals that pool with neighbors rather than their own sites should read regional antibiogram software for health systems, because pooling isolates across owners is a different project from pooling across your own sites.
What this does not do
- No NHSN AUR submission. Critical access hospitals meet that through their EHR or a certified surveillance product
- No real-time patient alerts, audit worklists or prospective review queues
- No EHR or HL7 interface. It works from exported files
- Not a prescribing tool. It summarizes susceptibility data for the pharmacist and physicians who set local guidance
Related reading: Paragon EHR antibiogram software, CPSI EHR antibiogram software, antibiotic stewardship software for critical access hospitals, nursing home antibiogram, hospital antibiogram software, WHONET alternative, antibiogram software for MEDITECH hospitals. The four steps from susceptibility testing data to an antibiogram cover the method end to end.
Questions
On this page's topic
Do critical access hospitals need an antibiogram?
CMS rule 42 CFR 485.640 requires a stewardship program but does not name the antibiogram. CDC's guidance for small and critical access hospitals says treatment decisions should ideally use local resistance data, with regional data when a local antibiogram is unavailable. In practice a current antibiogram is the evidence surveyors and prescribers expect.
What if we have fewer than 30 isolates of an organism?
Do not print a percentage for it. Pool two or three years of first isolates and print the window on the report, show the raw count instead of a percentage, or point prescribers to a regional report for that organism. Antimicrobe suppresses cells under 30 isolates automatically and shows the count.
Can a critical access hospital use a regional antibiogram?
Yes. CDC suggests regional resistance data when local antibiograms are unavailable, and many state health departments publish one. The limitation is that it describes other hospitals' patients. Most small hospitals use a pooled local report for urine and common organisms and the regional report for the rest.
How much does antibiogram software cost for a small hospital?
Antimicrobe costs $249 a month for one facility on the Lab plan, bought by card, or $749 a month for up to three facilities with unit cuts, quarterly trends and MDRO counts. Enterprise surveillance platforms do not publish prices and are sold with an implementation fee plus an annual license.
Do we need IT or an interface to use it?
No. You upload the CSV line list your lab, instrument data manager or reference lab already produces, and the report builds in a browser. There is no EHR or HL7 interface to build, which is why a pharmacist can set it up without an IT ticket.
Can we include swing bed, clinic and nursing home cultures?
Yes. On the Stewardship plan each site is a separate facility, so you can pool them into one community antibiogram or compare them side by side. Swing bed cultures from the hospital's own lab are already in the hospital export and can be cut by unit if the export carries it.
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