Drug-Bug Mismatch Help
Back to DashboardOverview
The Drug-Bug Mismatch module provides real-time surveillance of culture results and antimicrobial therapy to identify patients whose organisms are not adequately covered by their current treatment. This enables rapid ASP intervention to optimize therapy and improve patient outcomes.
How It Works
- Culture Monitoring: The system monitors all positive culture results from microbiology
- Therapy Review: Current antimicrobial orders are retrieved for patients with positive cultures
- Coverage Analysis: Susceptibility results are compared against the spectrum of current antibiotics
- Mismatch Detection: Alerts are generated when coverage gaps are identified
- Recommendations: Alternative therapy options are suggested based on susceptibilities and guidelines
Mismatch Categories
| Category | Priority | Description | Action Required |
|---|---|---|---|
| Complete Resistance | Critical | Organism is resistant (R) to all current antimicrobials | Urgent therapy change needed |
| Partial Coverage | High | Organism has intermediate (I) susceptibility or borderline MICs | Consider dose optimization or alternative |
| No Active Therapy | High | Positive culture but patient not on any antimicrobials | Evaluate need for treatment initiation |
| Spectrum Excess | Medium | Current therapy broader than needed for identified organism | De-escalation opportunity |
| Duplicate Coverage | Low | Multiple agents covering same spectrum unnecessarily | Consider streamlining regimen |
Coverage Rules
The system uses evidence-based coverage rules to determine antimicrobial-organism matching:
Gram-Positive Coverage
- MSSA: Cefazolin, nafcillin, oxacillin (preferred); alternatives based on susceptibilities
- MRSA: Vancomycin, daptomycin, linezolid, ceftaroline
- VRE: Daptomycin, linezolid, tigecycline (based on species and susceptibilities)
- Streptococci: Penicillin, ampicillin, ceftriaxone (check for resistance)
Gram-Negative Coverage
- Enterobacterales: Based on susceptibility testing; watch for ESBL, AmpC, CRE patterns
- Pseudomonas: Requires anti-pseudomonal agent; check susceptibilities for each isolate
- Acinetobacter: Often MDR; susceptibility-guided therapy essential
Special Pathogens
- Candida: Species identification important; fluconazole for susceptible species, echinocandin for resistant
- Anaerobes: Metronidazole, carbapenems, beta-lactam/beta-lactamase inhibitors
Alert Workflow
- Detection: System identifies mismatch based on culture + therapy + susceptibilities
- Alert Generation: Alert sent to ASP queue with patient details and recommendations
- Review: ASP pharmacist reviews alert and patient context
- Intervention: Recommendation made to primary team if indicated
- Resolution: Alert resolved with outcome tracking
Integration Points
- ASP Alerts: Mismatches generate alerts in the ASP Alerts queue
- HAI Detection: Mismatch data informs HAI candidate assessment
- NHSN Reporting: Resistance patterns contribute to AR reporting