Urgent care and ambulatory
Outpatient antibiogram software, an urgent care antibiogram and ambulatory antibiogram built from your reference lab cultures
Most urgent care prescribers pick an antibiotic for cystitis from a hospital antibiogram built on inpatient isolates, or from no local data at all. Your own clinics already send hundreds of urine cultures a year to a reference lab. That is enough for an outpatient antibiogram of your own.
Try the builder on the sample data, or drop in your own CSV. It is parsed in your browser and never uploaded.
Short answer
An outpatient antibiogram is a cumulative susceptibility report built only from cultures collected in ambulatory settings, such as urgent care centers, primary care clinics and emergency departments that discharge home. Antimicrobe builds it from the CSV line list your reference lab or hospital outreach lab can export, keeps the first isolate per patient per organism, suppresses any percentage resting on fewer than 30 isolates, and prints the count behind each number. The Lab plan is $249 a month by card; clinic-by-clinic cuts are on the Stewardship plan at $749.
Why the hospital antibiogram misleads urgent care prescribers
A hospital antibiogram pools every isolate the lab sees: ICU sputum, long-stay patients cultured five times, transfers from nursing homes. Community urinary E. coli from a 30-year-old with cystitis is a small share of that pool, and it tends to be more susceptible than the hospital average. Published comparisons of hospital-wide and location-stratified antibiograms have found that the institution-wide report can overestimate or underestimate resistance for specific patient groups, which is why CLSI M39 describes stratifying by location, including inpatient versus outpatient.
Novant Health and Labcorp put the problem plainly in a 2023 abstract in Open Forum Infectious Diseases: empiric antibiotic selection in outpatient care often relies on inpatient antibiograms which may not accurately reflect ambulatory susceptibility rates. They built a North Carolina ambulatory urine antibiogram from 2020 and 2021 cultures to fix exactly that.
The practical stakes are specific. IDSA's guideline for uncomplicated cystitis advises against trimethoprim-sulfamethoxazole as empiric therapy where local resistance among uropathogens exceeds 20 percent. An urgent care group cannot apply that rule honestly without knowing its own outpatient E. coli rate, and the hospital number is the wrong one to check it against.
Where an urgent care network's culture data actually lives
Urgent care groups and multi-site clinics rarely run their own microbiology. Cultures go to a national reference lab, a regional lab or the outreach arm of a local hospital, and results come back into the EHR as reports. The data you need is still at the lab, one row per isolate and drug, and most labs will produce a line list for a client on request.
Ask for a CSV covering at least 12 months with these columns: a patient identifier or MRN, collection date, specimen source, the ordering site or clinic, organism, antibiotic and the S, I or R interpretation. MIC values help but are not required. If the lab can only send a monthly file, upload the months together; the engine de-duplicates across them.
- National reference lab: request a client-level susceptibility line list as CSV, filtered to your account numbers
- Hospital outreach lab: ask the microbiology supervisor for an extract filtered to your ordering locations
- Your own EHR: some urgent care EHRs store discrete culture results, but many store the lab report as text, so the lab file is usually cleaner
- Patient identifiers are hashed on upload and never stored, because the first-isolate rule only needs a consistent key
Outpatient antibiogram options for an urgent care group
A published state or reference lab ambulatory antibiogram is a reasonable fallback, and the Novant and Labcorp authors concluded their state-wide report was close enough to their own system's data to use across regions. The gap is that it rarely exists for your state, it arrives once a year, and it cannot tell you whether your pediatric clinics or one metro area differ.
| Option | Whose patients it describes | Who builds it | Cost |
|---|---|---|---|
| Local hospital antibiogram | Mostly inpatients at that hospital | Hospital lab or pharmacy | Free to read, wrong population |
| State or reference lab ambulatory antibiogram | Outpatients across a state or region, where one is published | Health department or the lab | Free where it exists, not your clinics |
| Excel by hand from a lab extract | Your patients | A medical director or pharmacist, yearly | No license, days of work, rules applied inconsistently |
| WHONET | Your patients | One person on a Windows PC, after BacLink setup | Free software, your hours |
| Antimicrobe Lab | Your patients, as one facility | Whoever owns stewardship, in a browser | $249 a month, by card |
| Antimicrobe Stewardship | Your patients, cut by clinic or region | Same | $749 a month, up to 3 facilities and 8 seats |
What the Joint Commission ambulatory stewardship standard asks for
Since January 1, 2020, The Joint Commission's Ambulatory Health Care program has carried an antimicrobial stewardship standard, MM.09.01.03, described in R3 Report Issue 23. Its elements of performance ask the organization to name a person responsible for stewardship, set at least one annual stewardship goal, use evidence-based practice guidelines related to that goal, give clinicians education on it, and collect, analyze and report data on it.
The standard does not require an antibiogram. But the most common ambulatory goal is urinary tract infection prescribing, and a local urine antibiogram is the data that makes the guideline step and the data step concrete: you pick first-line agents from your own susceptibility and show the committee the numbers behind the choice.
Hospital-based programs follow different requirements, covered on the Joint Commission antimicrobial stewardship page. The urine-specific cut, with nitrofurantoin, TMP-SMX and ciprofloxacin side by side, is described on the UTI antibiotic resistance page.
How it works for an urgent care or clinic group
The builder at the top of this page runs the same rules on sample data, so you can see what an outpatient urine antibiogram with a suppressed cell looks like before you buy.
- Request 12 to 24 months of culture results from your lab as a CSV and upload it. Common export headings (patient or MRN, organism, antibiotic, result) are recognized automatically
- The engine keeps the first isolate per patient per organism in the period, so a patient re-cultured after treatment failure counts once
- Cells under 30 isolates are suppressed and shown as counts. Most groups get reliable urine E. coli and Klebsiella figures in the first year and pool two years for Proteus and Enterococcus
- Cut by specimen source first (urine versus skin and soft tissue versus everything else), then by clinic or region on the Stewardship plan, and print or export the report for the medical director and clinician education
Which plan fits which outpatient group
A single urgent care brand that wants one network-wide outpatient antibiogram fits the Lab plan: upload the whole network as one facility, with cuts by source and period, for $249 a month. A group that wants to compare clinics or regions needs the unit cut, which is on the Stewardship plan at $749 a month with 8 seats; the ordering clinic goes in the unit column of the export. A large multi-state group or an ACO that wants up to 12 separately reported entities on one rule set fits the Network plan at $2,400 a month.
Every limit is on the pricing page. Health systems that also want the inpatient report cut from the same lab data should look at hospital antibiogram software, and groups pooling with other owners at regional antibiogram software.
What this does not do
- No prescribing-rate tracking. Outpatient stewardship programs also measure how often antibiotics are prescribed for viral respiratory visits; that comes from your EHR or claims data, not a susceptibility file
- No EHR or HL7 interface. It works from exported files
- No patient-level alerts or culture follow-up queues
- Not a prescribing tool. It summarizes susceptibility for the medical director and clinicians who set the group's empiric guidance
Related reading: UTI antibiotic resistance by source, empiric antibiotic therapy from local data, hospital antibiogram software, lab susceptibility export. The four steps from susceptibility testing data to an antibiogram cover the method end to end.
Questions
On this page's topic
Do urgent care centers need their own antibiogram?
No rule requires one, but it is the most direct evidence for empiric UTI choices. IDSA advises against TMP-SMX for cystitis where local uropathogen resistance exceeds 20 percent, and a hospital antibiogram built on inpatients is the wrong number to check that against. An outpatient urine antibiogram from your own cultures answers it.
Can we use the local hospital antibiogram for outpatient prescribing?
It is better than nothing, but it describes mostly inpatients, including repeatedly cultured and long-stay patients, so it often shows more resistance than community urinary isolates. CLSI M39 describes stratifying inpatient and outpatient isolates for that reason. If the hospital publishes an outpatient cut, use it; otherwise build one from your own lab data.
Where do we get the data if our cultures go to Quest or Labcorp?
Ask your lab account representative or client services for a susceptibility line list for your account numbers, as CSV, covering 12 to 24 months. It should carry a patient identifier, collection date, specimen source, ordering site, organism, antibiotic and the S, I or R result. Hospital outreach labs can usually produce the same extract.
How many isolates does an outpatient antibiogram need?
CLSI M39 says not to report a percent susceptible on fewer than 30 isolates of an organism in the period. A multi-site urgent care group usually clears that for urine E. coli within a year. For less common organisms, pool two years and print the window, or show the count instead of a percentage.
How much does outpatient antibiogram software cost?
Antimicrobe costs $249 a month on the Lab plan for one network-wide report, bought by card, or $749 a month on the Stewardship plan to cut by clinic or region with 8 seats. There is no implementation fee and no interface to build. Building it by hand costs no license but takes days each year.
Does it track antibiotic prescribing rates for respiratory visits?
No. Prescribing rates come from visit and prescription data in your EHR or claims, and this product works only on culture and susceptibility results. Many outpatient programs use both: an EHR report for prescribing rates and an antibiogram for choosing the first-line agent.
More on antimicrobial resistance reporting
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