{ "hospital": { "name": "Riyadh Third Health Cluster", "region": "Riyadh", "bedCapacity": 200, "microbiologist": "Dr. Doaa Mohamed Sherif", "dataYear": 2025 }, "antibiogram": { "gramNegative": { "overall": { "AMK": 0.89, "AMC": 0.64, "AMP": 0.16, "CEPHAZ": 0.52, "CPM": 0.75, "CTX": 0.59, "FOX": 0.55, "CAZ": 0.71, "CRO": 0.59, "CXM": 0.42, "CIP": 0.55, "LEV": 0.55, "GM": 0.85, "IPM": 0.79, "MEM": 0.79, "TGC": 0.89, "F": 0.61, "TZP": 0.81, "TOB": 0.85, "SXT": 0.64 }, "organisms": { "E. coli": { "count": 308, "sensitivity": { "AMK": 0.92, "AMC": 0.56, "AMP": 0.20, "CEPHAZ": 0.65, "CPM": 0.78, "CTX": 0.65, "FOX": 0.58, "CAZ": 0.70, "CRO": 0.65, "CXM": 0.49, "CIP": 0.60, "LEV": 0.60, "GM": 0.91, "IPM": 0.95, "MEM": 0.95, "TGC": 0.94, "F": 0.86, "TZP": 0.91, "TOB": 0.91, "SXT": 0.90 } }, "K. pneumoniae": { "count": 323, "sensitivity": { "AMK": 0.87, "AMC": 0.60, "AMP": 0.01, "CEPHAZ": 0.40, "CPM": 0.70, "CTX": 0.50, "FOX": 0.48, "CAZ": 0.70, "CRO": 0.50, "CXM": 0.34, "CIP": 0.51, "LEV": 0.51, "GM": 0.80, "IPM": 0.62, "MEM": 0.62, "TGC": 0.93, "F": 0.53, "TZP": 0.70, "TOB": 0.80, "SXT": 0.51 } }, "P. aeruginosa": { "count": 160, "sensitivity": { "AMK": 0.80, "CAZ": 0.70, "CFM": 0.72, "CIP": 0.60, "GM": 0.77, "IPM": 0.80, "LVX": 0.60, "MEM": 0.80, "TOB": 0.80, "TZP": 0.75 } }, "A. baumannii": { "count": 51, "sensitivity": { "AMK": 0.35, "CAZ": 0.30, "CFM": 0.30, "CIP": 0.25, "GM": 0.35, "IPM": 0.69, "LVX": 0.25, "MEM": 0.35, "TGC": 0.40, "TOB": 0.35, "SXT": 0.50, "TZP": 0.25 } }, "Proteus mirabilis": { "count": 53, "sensitivity": { "AMK": 0.92, "AMC": 0.53, "AMP": 0.26, "CEPHAZ": 0.45, "CPM": 0.85, "CTX": 0.85, "FOX": 0.72, "CAZ": 0.85, "CRO": 0.85, "CXM": 0.47, "CIP": 0.51, "LEV": 0.51, "GM": 0.81, "IPM": 0.85, "MEM": 0.85, "TGC": 0.38, "TZP": 0.87, "TOB": 0.81, "SXT": 0.87 } }, "Enterobacter": { "count": 4, "sensitivity": {} }, "Serratia": { "count": 28, "sensitivity": {} }, "Citrobacter": { "count": 10, "sensitivity": {} }, "Salmonella": { "count": 6, "sensitivity": {} } } }, "gramPositive": { "S. aureus": { "count": 184, "sensitivity": { "AMC": 0.40, "AMP": 0.38, "PEN": 0.21, "CIP": 0.81, "CLI": 0.73, "ERY": 0.60, "GM": 0.87, "LVX": 0.82, "LZD": 1.00, "FOX": 0.45, "OXA": 0.45, "TET": 0.80, "SXT": 0.82, "VAN": 1.00, "TEICO": 1.00, "TGC": 1.00 } }, "CoNS": { "count": 180, "sensitivity": { "AMC": 0.30, "AMP": 0.30, "PEN": 0.27, "CIP": 0.73, "CLI": 0.53, "ERY": 0.54, "GM": 0.55, "LVX": 0.75, "LZD": 1.00, "FOX": 0.35, "OXA": 0.35, "TET": 0.60, "SXT": 0.85, "VAN": 1.00, "TEICO": 1.00, "TGC": 1.00 } }, "E. faecalis": { "count": 56, "sensitivity": { "AMP": 0.60, "PEN": 0.55, "CIP": 0.75, "GM": 0.70, "LVX": 0.75, "LZD": 1.00, "TET": 0.25, "VAN": 1.00, "TEICO": 1.00, "TGC": 1.00 } } }, "fungal": { "Candida albicans": { "count": 34, "sensitivity": { "FLU": 1.00, "ITR": 0.83, "AMB": 1.00, "CAS": 1.00, "5FC": 0.90, "VRC": 0.87, "MCF": 0.75 } }, "Candida auris": { "count": 15, "sensitivity": {} }, "Candida glabrata": { "count": 9, "sensitivity": {} }, "Candida Tropicalis": { "count": 13, "sensitivity": {} } }, "mdro": { "KLEB_ESBL": 0.21, "KLEB_CRE": 0.28, "ECOLI_ESBL": 0.21, "ECOLI_CRE": 0.00, "CRPA": 0.20, "CRAB": 0.31 } }, "diagnoses": [ { "id": "cap", "name": "Community-Acquired Pneumonia", "category": "Respiratory", "organisms": ["Streptococcus pneumoniae", "Haemophilus influenzae", "Mycoplasma pneumoniae"], "firstLine": { "drug": "Amoxicillin-clavulanate", "dose": "1g PO q8h", "duration": "7 days", "route": "Oral" }, "alternatives": [ { "drug": "Ceftriaxone", "dose": "2g IV q24h", "duration": "7 days" }, { "drug": "Azithromycin", "dose": "500mg PO daily", "duration": "5 days" } ], "restricted": [ { "drug": "Meropenem", "reason": "Reserve for severe/hospital-acquired pneumonia" } ], "resistanceData": { "Amoxicillin-clavulanate": 0.64, "Ceftriaxone": 0.59, "Azithromycin": 0.60 }, "recommendations": [ "Send sputum culture before starting antibiotics", "Consider CURB-65 score for severity", "Review at 48-72 hours", "Switch to oral when clinically stable" ], "specialWarnings": [ "Renal adjustment: reduce dose if CrCl < 30" ] }, { "id": "hap", "name": "Hospital-Acquired Pneumonia", "category": "Respiratory", "organisms": ["Klebsiella pneumoniae", "Pseudomonas aeruginosa", "Staphylococcus aureus"], "firstLine": { "drug": "Piperacillin-Tazobactam", "dose": "4.5g IV q8h", "duration": "7 days", "route": "IV" }, "alternatives": [ { "drug": "Cefepime", "dose": "2g IV q8h", "duration": "7 days" }, { "drug": "Levofloxacin", "dose": "750mg IV daily", "duration": "7 days" } ], "restricted": [ { "drug": "Meropenem", "reason": "Reserve for MDR infections" } ], "resistanceData": { "Piperacillin-Tazobactam": 0.81, "Cefepime": 0.75, "Levofloxacin": 0.55 }, "recommendations": [ "Send sputum culture and blood cultures", "Review at 48-72 hours", "De-escalate based on culture results" ], "specialWarnings": [ "Renal adjustment required" ] }, { "id": "vap", "name": "Ventilator-Associated Pneumonia", "category": "Respiratory", "organisms": ["Pseudomonas aeruginosa", "Klebsiella pneumoniae", "Acinetobacter baumannii", "Staphylococcus aureus"], "firstLine": { "drug": "Meropenem + Vancomycin", "dose": "1g IV q8h + 1g IV q12h", "duration": "7-8 days", "route": "IV" }, "alternatives": [ { "drug": "Piperacillin-Tazobactam + Vancomycin", "dose": "4.5g IV q8h + 1g IV q12h", "duration": "7-8 days" }, { "drug": "Cefepime + Vancomycin", "dose": "2g IV q8h + 1g IV q12h", "duration": "7-8 days" } ], "restricted": [ { "drug": "Colistin", "reason": "Reserve for MDR Acinetobacter/Pseudomonas" }, { "drug": "Tigecycline", "reason": "Reserve for MDR Acinetobacter" } ], "resistanceData": { "Meropenem": 0.79, "Vancomycin": 1.00, "Piperacillin-Tazobactam": 0.81, "Cefepime": 0.75 }, "recommendations": [ "Send bronchoalveolar lavage (BAL) or endotracheal aspirate", "Monitor for de-escalation at 48-72 hours", "Consider shorter duration (7 days) if clinical improvement" ], "specialWarnings": [ "CRAB rate: 31% - consider colistin if high risk", "CRPA rate: 20% - consider combination therapy" ] }, { "id": "copd", "name": "COPD Exacerbation", "category": "Respiratory", "organisms": ["Haemophilus influenzae", "Streptococcus pneumoniae", "Moraxella catarrhalis"], "firstLine": { "drug": "Amoxicillin-clavulanate", "dose": "1g PO q8h", "duration": "5-7 days", "route": "Oral" }, "alternatives": [ { "drug": "Doxycycline", "dose": "100mg PO q12h", "duration": "7 days" }, { "drug": "Azithromycin", "dose": "500mg PO daily x 3 days", "duration": "3 days" } ], "restricted": [], "resistanceData": { "Amoxicillin-clavulanate": 0.64, "Doxycycline": 0.80, "Azithromycin": 0.60 }, "recommendations": [ "Consider viral etiology", "Assess severity with GOLD criteria", "Review at 48-72 hours" ], "specialWarnings": [ "Avoid antibiotics if only purulent sputum without other signs" ] }, { "id": "bronchitis", "name": "Acute Bronchitis", "category": "Respiratory", "organisms": ["Viral (most)", "Streptococcus pneumoniae", "Haemophilus influenzae"], "firstLine": { "drug": "Supportive care only", "dose": "No antibiotics needed", "duration": "N/A", "route": "N/A" }, "alternatives": [ { "drug": "Amoxicillin-clavulanate", "dose": "1g PO q8h", "duration": "5 days" }, { "drug": "Doxycycline", "dose": "100mg PO q12h", "duration": "5 days" } ], "restricted": [], "resistanceData": { "Amoxicillin-clavulanate": 0.64 }, "recommendations": [ "Antibiotics rarely needed", "Symptomatic treatment (cough suppressants, hydration)", "Only prescribe if suspicion of bacterial superinfection" ], "specialWarnings": [ "Overuse of antibiotics in bronchitis contributes to resistance" ] }, { "id": "sinusitis", "name": "Acute Bacterial Sinusitis", "category": "Respiratory", "organisms": ["Streptococcus pneumoniae", "Haemophilus influenzae", "Moraxella catarrhalis"], "firstLine": { "drug": "Amoxicillin-clavulanate", "dose": "1g PO q8h", "duration": "7 days", "route": "Oral" }, "alternatives": [ { "drug": "Doxycycline", "dose": "100mg PO q12h", "duration": "7 days" }, { "drug": "Levofloxacin", "dose": "500mg PO daily", "duration": "7 days" } ], "restricted": [], "resistanceData": { "Amoxicillin-clavulanate": 0.64, "Levofloxacin": 0.55 }, "recommendations": [ "Symptoms >10 days or severe", "Consider CT if recurrent", "Review at 48-72 hours" ], "specialWarnings": [ "Avoid antibiotics if viral etiology suspected" ] }, { "id": "pharyngitis", "name": "Acute Pharyngitis", "category": "Respiratory", "organisms": ["Streptococcus pyogenes (Group A Strep)", "Viruses"], "firstLine": { "drug": "Amoxicillin", "dose": "500mg PO q8h", "duration": "10 days", "route": "Oral" }, "alternatives": [ { "drug": "Clarithromycin", "dose": "500mg PO q12h", "duration": "10 days" }, { "drug": "Clindamycin", "dose": "300mg PO q6h", "duration": "10 days" } ], "restricted": [], "resistanceData": { "Amoxicillin": 0.38, "Clarithromycin": 0.60, "Clindamycin": 0.73 }, "recommendations": [ "Use Centor criteria (fever, tonsillar exudate, tender cervical nodes, no cough)", "Consider rapid strep test", "Culture if negative but high suspicion" ], "specialWarnings": [ "Penicillin allergy: use macrolide or clindamycin" ] }, { "id": "otitis", "name": "Acute Otitis Media", "category": "Respiratory", "organisms": ["Streptococcus pneumoniae", "Haemophilus influenzae", "Moraxella catarrhalis"], "firstLine": { "drug": "Amoxicillin", "dose": "80-90 mg/kg/day PO divided q12h", "duration": "10 days", "route": "Oral" }, "alternatives": [ { "drug": "Amoxicillin-clavulanate", "dose": "1g PO q8h", "duration": "10 days" }, { "drug": "Ceftriaxone", "dose": "50mg/kg IM/IV x 3 days", "duration": "3 days" } ], "restricted": [], "resistanceData": { "Amoxicillin": 0.38, "Amoxicillin-clavulanate": 0.64, "Ceftriaxone": 0.59 }, "recommendations": [ "Children <2 years: treat immediately", "Children >2 years: observation option if mild" ], "specialWarnings": [ "Penicillin allergy: use macrolide" ] }, { "id": "uti", "name": "Acute Cystitis (Uncomplicated)", "category": "Urinary", "organisms": ["Escherichia coli", "Staphylococcus saprophyticus", "Klebsiella pneumoniae"], "firstLine": { "drug": "Nitrofurantoin", "dose": "100mg PO q12h", "duration": "5 days", "route": "Oral" }, "alternatives": [ { "drug": "Amoxicillin-clavulanate", "dose": "625mg PO q8h", "duration": "5 days" }, { "drug": "Trimethoprim-Sulfamethoxazole", "dose": "160/800mg PO q12h", "duration": "3 days" } ], "restricted": [ { "drug": "Tigecycline", "reason": "Reserve for MDR infections only" } ], "resistanceData": { "Nitrofurantoin": 0.86, "Amoxicillin-clavulanate": 0.56, "Trimethoprim-Sulfamethoxazole": 0.90, "Ciprofloxacin": 0.60 }, "recommendations": [ "Send urine culture if recurrent or complicated", "Avoid fluoroquinolones unless resistance documented", "Review at 48 hours if no improvement" ], "specialWarnings": [ "Nitrofurantoin contraindicated in CrCl < 30", "Avoid in pregnancy near term" ] }, { "id": "pyelo", "name": "Acute Pyelonephritis", "category": "Urinary", "organisms": ["Escherichia coli", "Klebsiella pneumoniae", "Pseudomonas aeruginosa", "Enterococcus"], "firstLine": { "drug": "Ceftriaxone", "dose": "2g IV q24h", "duration": "7-14 days", "route": "IV" }, "alternatives": [ { "drug": "Ciprofloxacin", "dose": "500mg PO q12h", "duration": "7-10 days" }, { "drug": "Amoxicillin-clavulanate", "dose": "1.2g IV q8h", "duration": "7-10 days" } ], "restricted": [ { "drug": "Meropenem", "reason": "Reserve for ESBL-producing organisms" }, { "drug": "Piperacillin-Tazobactam", "reason": "Reserve for complicated/MDR infections" } ], "resistanceData": { "Ceftriaxone": 0.59, "Ciprofloxacin": 0.55, "Amoxicillin-clavulanate": 0.56, "Meropenem": 0.95, "Piperacillin-Tazobactam": 0.81 }, "recommendations": [ "Send blood cultures and urine culture before antibiotics", "Consider IV-to-PO switch after 24-48 hours if improving", "Review at 48-72 hours" ], "specialWarnings": [ "Renal adjustment required for all antibiotics", "Consider imaging if no improvement in 72 hours" ] }, { "id": "cauti", "name": "Catheter-Associated UTI", "category": "Urinary", "organisms": ["Escherichia coli", "Klebsiella pneumoniae", "Pseudomonas aeruginosa", "Enterococcus"], "firstLine": { "drug": "Ceftriaxone", "dose": "2g IV q24h", "duration": "7-10 days", "route": "IV" }, "alternatives": [ { "drug": "Piperacillin-Tazobactam", "dose": "4.5g IV q8h", "duration": "7-10 days" }, { "drug": "Ciprofloxacin", "dose": "500mg PO q12h", "duration": "7-10 days" } ], "restricted": [ { "drug": "Meropenem", "reason": "Reserve for MDR infections" } ], "resistanceData": { "Ceftriaxone": 0.59, "Piperacillin-Tazobactam": 0.81, "Ciprofloxacin": 0.55 }, "recommendations": [ "Remove or change catheter", "Send urine culture before antibiotics", "Review at 48-72 hours" ], "specialWarnings": [ "Asymptomatic bacteriuria: do not treat" ] }, { "id": "prostatitis", "name": "Acute Prostatitis", "category": "Urinary", "organisms": ["Escherichia coli", "Klebsiella pneumoniae", "Pseudomonas aeruginosa", "Enterococcus"], "firstLine": { "drug": "Ciprofloxacin", "dose": "500mg PO q12h", "duration": "14-21 days", "route": "Oral" }, "alternatives": [ { "drug": "Levofloxacin", "dose": "750mg PO daily", "duration": "14 days" }, { "drug": "Trimethoprim-Sulfamethoxazole", "dose": "160/800mg PO q12h", "duration": "14 days" } ], "restricted": [], "resistanceData": { "Ciprofloxacin": 0.55, "Levofloxacin": 0.55, "Trimethoprim-Sulfamethoxazole": 0.90 }, "recommendations": [ "Send urine culture before antibiotics", "Digital rectal exam may be deferred until after antibiotics", "Review at 48-72 hours" ], "specialWarnings": [ "Quinolones have good prostate penetration", "Duration: 2-4 weeks" ] }, { "id": "cellulitis", "name": "Cellulitis", "category": "Skin/Soft Tissue", "organisms": ["Staphylococcus aureus", "Streptococcus pyogenes"], "firstLine": { "drug": "Cloxacillin", "dose": "500mg PO q6h", "duration": "7-10 days", "route": "Oral" }, "alternatives": [ { "drug": "Clindamycin", "dose": "600mg IV q8h", "duration": "7-10 days" }, { "drug": "Cefazolin", "dose": "2g IV q8h", "duration": "7-10 days" } ], "restricted": [ { "drug": "Vancomycin", "reason": "Reserve for MRSA or severe infections" }, { "drug": "Linezolid", "reason": "Reserve for MRSA/VRE infections" } ], "resistanceData": { "Cloxacillin": 0.45, "Clindamycin": 0.73, "Vancomycin": 1.00 }, "recommendations": [ "Send wound culture if purulent", "Mark the border of erythema", "Review at 48-72 hours", "Consider IV-to-PO switch after 24-48 hours" ], "specialWarnings": [ "MRSA rate: 55% - consider vancomycin if severe or no improvement" ] }, { "id": "dfi", "name": "Diabetic Foot Infection", "category": "Skin/Soft Tissue", "organisms": ["Staphylococcus aureus", "Pseudomonas aeruginosa", "Anaerobes", "GNR"], "firstLine": { "drug": "Piperacillin-Tazobactam", "dose": "4.5g IV q8h", "duration": "7-14 days", "route": "IV" }, "alternatives": [ { "drug": "Ciprofloxacin + Metronidazole", "dose": "400mg IV q12h + 500mg IV q8h", "duration": "7-14 days" }, { "drug": "Vancomycin + Cefepime", "dose": "1g IV q12h + 2g IV q8h", "duration": "7-14 days" } ], "restricted": [ { "drug": "Meropenem", "reason": "Reserve for MDR infections" }, { "drug": "Tigecycline", "reason": "Reserve for MDR infections" } ], "resistanceData": { "Piperacillin-Tazobactam": 0.81, "Ciprofloxacin": 0.55, "Vancomycin": 1.00, "Meropenem": 0.79 }, "recommendations": [ "Send deep tissue culture or bone biopsy", "Consider surgical debridement", "Check HbA1c and optimize glycemic control", "Review at 48-72 hours" ], "specialWarnings": [ "Renal adjustment required", "Consider vascular assessment" ] }, { "id": "ssi", "name": "Surgical Site Infection", "category": "Skin/Soft Tissue", "organisms": ["Staphylococcus aureus", "GNR", "Enterococcus", "Anaerobes"], "firstLine": { "drug": "Piperacillin-Tazobactam", "dose": "4.5g IV q8h", "duration": "7-10 days", "route": "IV" }, "alternatives": [ { "drug": "Vancomycin + Ceftriaxone", "dose": "1g IV q12h + 2g IV q24h", "duration": "7-10 days" }, { "drug": "Cefepime + Metronidazole", "dose": "2g IV q8h + 500mg IV q8h", "duration": "7-10 days" } ], "restricted": [ { "drug": "Meropenem", "reason": "Reserve for MDR infections" } ], "resistanceData": { "Piperacillin-Tazobactam": 0.81, "Vancomycin": 1.00, "Cefepime": 0.75 }, "recommendations": [ "Send wound culture before antibiotics", "Consider surgical drainage", "Review at 48-72 hours" ], "specialWarnings": [ "MRSA rate: 55% - consider vancomycin" ] }, { "id": "necrotizing", "name": "Necrotizing Fasciitis", "category": "Skin/Soft Tissue", "organisms": ["Streptococcus pyogenes", "Staphylococcus aureus", "Anaerobes", "GNR"], "firstLine": { "drug": "Piperacillin-Tazobactam + Vancomycin", "dose": "4.5g IV q8h + 1g IV q12h", "duration": "Surgical dependent", "route": "IV" }, "alternatives": [ { "drug": "Cefepime + Vancomycin + Metronidazole", "dose": "2g IV q8h + 1g IV q12h + 500mg IV q8h", "duration": "Surgical dependent" } ], "restricted": [ { "drug": "Linezolid", "reason": "Reserve for MRSA" } ], "resistanceData": { "Piperacillin-Tazobactam": 0.81, "Vancomycin": 1.00, "Cefepime": 0.75 }, "recommendations": [ "Emergency surgical debridement", "Send tissue culture and blood cultures", "ICU admission", "Review daily" ], "specialWarnings": [ "Surgical emergency - do not delay surgery", "High mortality if delayed" ] }, { "id": "abscess", "name": "Skin Abscess", "category": "Skin/Soft Tissue", "organisms": ["Staphylococcus aureus", "Anaerobes"], "firstLine": { "drug": "Incision and drainage (I&D) only", "dose": "No antibiotics needed if uncomplicated", "duration": "N/A", "route": "N/A" }, "alternatives": [ { "drug": "Clindamycin", "dose": "300mg PO q6h", "duration": "5-7 days" }, { "drug": "Trimethoprim-Sulfamethoxazole", "dose": "160/800mg PO q12h", "duration": "5-7 days" } ], "restricted": [ { "drug": "Vancomycin", "reason": "Reserve for severe infections" } ], "resistanceData": { "Clindamycin": 0.73, "Trimethoprim-Sulfamethoxazole": 0.90 }, "recommendations": [ "Incision and drainage is the primary treatment", "Antibiotics only if extensive, severe, or immunocompromised", "Send culture if purulent" ], "specialWarnings": [ "MRSA rate: 55% - consider anti-MRSA antibiotics if needed" ] }, { "id": "sepsis", "name": "Sepsis (Unknown Source)", "category": "Bloodstream", "organisms": ["Staphylococcus aureus", "Escherichia coli", "Klebsiella pneumoniae", "Pseudomonas aeruginosa"], "firstLine": { "drug": "Piperacillin-Tazobactam", "dose": "4.5g IV q8h", "duration": "7-10 days", "route": "IV" }, "alternatives": [ { "drug": "Ceftriaxone + Vancomycin", "dose": "2g IV q24h + 1g IV q12h", "duration": "7-10 days" }, { "drug": "Cefepime + Vancomycin", "dose": "2g IV q8h + 1g IV q12h", "duration": "7-10 days" } ], "restricted": [ { "drug": "Meropenem", "reason": "Reserve for ESBL/MDR infections" }, { "drug": "Colistin", "reason": "Reserve for MDR Acinetobacter/Pseudomonas" } ], "resistanceData": { "Piperacillin-Tazobactam": 0.81, "Ceftriaxone": 0.59, "Vancomycin": 1.00, "Cefepime": 0.75, "Meropenem": 0.79 }, "recommendations": [ "Send blood cultures (2 sets) before antibiotics", "Administer antibiotics within 1 hour", "Source control if identified", "Review at 48-72 hours", "De-escalate based on culture results" ], "specialWarnings": [ "Vancomycin trough: 10-15 mcg/mL", "Renal adjustment required for all antibiotics", "Consider MDRO risk factors" ] }, { "id": "severe_sepsis", "name": "Severe Sepsis / Septic Shock", "category": "Bloodstream", "organisms": ["Staphylococcus aureus", "Escherichia coli", "Klebsiella