Antibiotic Stewardship

Antibiotic Stewardship Antibiotic Start Reporting Program How to Report Indication

How to Report Indication

This job aid describes each of the indications available in the Antibiotic Start Reporting Program REDCap survey. The purpose is to help reporters select the appropriate indication for antibiotic starts submitted to the MDPH Antibiotic Start Reporting Program.

Indication Categories

There may be several conditions and diagnoses that fall into one of the indications. For example, 'urinary tract infection' includes cystitis, pyelonephritis, and catheter-associated UTI. Although the specific complications or location of the infection may differ, these are all infections of the urinary tract and should be reported as such.

The specific conditions and diagnoses included in each indication category are listed below. All specific conditions and diagnoses in an indication category should be reported by the indication category name in the dropdown list. Do not report as “Other.” For more general information regarding the Antibiotic Start Reporting Program see the frequently asked questions.

Urogenital infections including urinary tract infections

Urinary tract infections (UTI) are infections of the urinary system. The urinary tract includes the bladder, kidneys, ureters and urethra. Select “urinary tract infection” as the indication for any of the following:

  • UTI
  • Cystitis
  • Pyelonephritis
  • Complicated UTI
  • Catheter-associated UTI
  • Scrotal abscess
  • Prostatitis
  • Prostate abscess
  • Bacterial vaginosis

Pneumonia

Pneumonia and other lower respiratory tract infections are infections that affect the lower airway below the larynx (voice box). Pneumonia is a lower respiratory tract infection that inflames the air sacs of the lungs. Other lower respiratory tract infections include:

  • Ventilator associated pneumonia
  • Hospital acquired pneumonia
  • Community acquired pneumonia
  • Aspiration pneumonia

Skin and soft tissue infection

Skin and soft tissue infections can occur in all layers of the skin, from the epidermis to the subcutaneous tissue. Skin and soft tissue infections can also reach the muscle. Skin and soft tissue infections include:

  • Impetigo
  • Cellulitis
  • Erysipelas
  • Skin abscess *
  • Wound (including surgical wounds)
  • Folliculitis *
  • Furuncle *
  • Boil *
  • Pressure injury infections, decubitus ulcers
  • Diabetic foot infection excluding osteomyelitis

Intraabdominal infection

Intraabdominal infections occur in the abdominal cavity. Intraabdominal infections include:

  • Diverticulitis
  • Peritonitis
  • Intraabdominal abscess
  • Colitis or enteritis not including C. difficile infection
  • Cholecystitis
  • Cholangitis
  • Pancreatitis *
  • Appendicitis
  • Liver abscess
  • Gastroenteritis including norovirus *

C. difficile infection

C. difficile infection (CDI) is characterized by diarrhea and inflammation of the colon caused by Clostridioides difficile bacteria. CDI is often referred to as "C. diff".

Bone and joint infection

Bone and joint infections are infections of the bone or synovial fluid within the joint and often require hospitalization and IV antibiotics. Bone and joint infections include:

  • Osteomyelitis
  • Septic arthritis
  • Prosthetic joint infections
  • Vertebral osteomyelitis
  • Epidural abscess

Infective endocarditis

Infective endocarditis is an infection of the inner lining of the heart.

Chronic suppression

Chronic suppression is prolonged antibiotic therapy to suppress symptoms of active infection when cure is not expected or possible, such as prosthetic joint infection with implant retention.

Prophylaxis

Prophylaxis includes antibiotics used for the prevention of infectious diseases, such as recurrent urinary tract infection and prevention of infection before or after surgeries or other procedures. Note: Methenamine (Hiprex), commonly used for UTI prophylaxis, is not considered an antibiotic and not reportable.

Upper respiratory tract infection including ear, nose, and throat

Upper respiratory tract infections are those that occur in the respiratory system including the larynx (voice box) and above. Upper respiratory tract infections include:

  • Pharyngitis (sore throat)
  • Strep throat
  • Laryngitis
  • Epiglottitis
  • Parotitis
  • Sialadenitis
  • Sinusitis *
  • Ear infections

Unknown

Indication is not documented in the electronic health record (EHR). Indication for each antibiotic start should be documented in the EHR. An antibiotic prescription without a documented indication should be investigated. The CDC Core Elements of Antibiotic Stewardship for Nursing Homes includes tacking how and why antibiotics are prescribed as a key stewardship activity.

Other lower respiratory tract infection excluding pneumonia

  • Bronchitis *
  • Bronchiolitis *
  • COPD Exacerbation *

Suspected infection with unknown source

Antibiotic prescribed for a suspected infection without a clear source (e.g. leukocytosis, fever, empiric coverage).

Bacteremia, sepsis, septicemia

Bacteremia is the presence of bacteria in the blood. Bacteremia can progress to a more severe bloodstream infection referred to as septicemia. Sepsis is a life-threatening condition characterized by organ dysfunction.

Dental infection

Dental infections originate in the tooth or its supporting structures and can spread to the surrounding tissues of the mouth. Dental infections include:

  • Dental abscess
  • Periodontitis

Eye infection

Eye infections can occur in virtually any part of the eye, from the eyelid to the retina. Eye infections include:

  • Conjunctivitis
  • Stye
  • Endophthalmitis
  • Scleritis
  • Uveitis
  • Chorioretinitis

Other

Only report an antibiotic start as “Other” if the indication in not included in one of the categories above.


*Antibiotics are not always indicated for this condition.