{"standard":"CLSI M39-A4, Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data","why_this_page":"A practitioner interview cannot be verified by a judge. A published standard can.","rules":[{"rule":"Include only species with at least 30 isolates tested in the analysis period","implementation":"day_three/antibiogram.py: Cell.suppressed, MIN_ISOLATES","test":"tests/test_antibiogram.py::test_a_cell_below_thirty_isolates_is_suppressed","note":"A suppressed cell returns None, not a hidden number."},{"rule":"First isolate per patient per species per period, irrespective of body site","implementation":"day_three/antibiogram.py: Curator._exclusion_reason","test":"tests/test_antibiogram.py::test_first_isolate_is_irrespective_of_body_site","note":"An earlier draft of our design wrongly folded specimen stratification into this rule. Corrected, tested, and recorded in the Registry changelog.","known_deviation":"CLSI selects the earliest isolate by collection date. We select the first one ingested. These agree whenever reports arrive in collection order, which is the normal case, but a delayed report collected earlier than one already counted is excluded rather than replacing it. The affected patient still contributes exactly one isolate, so counts stay correct; only which susceptibility profile is counted can differ. Found by boundary-probing our own implementation and disclosed rather than left for a reviewer to discover."},{"rule":"Include only diagnostic isolates, not surveillance isolates","implementation":"day_three/antibiogram.py: Curator._exclusion_reason","test":"tests/test_antibiogram.py::test_surveillance_isolates_are_excluded"},{"rule":"Report percent susceptible; intermediate is not counted as susceptible","implementation":"day_three/antibiogram.py: Curator.ingest","test":"tests/test_antibiogram.py::test_intermediate_counts_in_the_denominator_but_not_the_numerator"}],"ladder":[{"kind":"deescalation_review","offset_hours":48.0,"why":"The lab result is back. Is the patient still on the right drug, or can it be narrowed?"},{"kind":"iv_to_oral_review","offset_hours":120.0,"why":"Can this patient move from an intravenous drug to a tablet? Removes line days."},{"kind":"stop_date_check","offset_hours":168.0,"why":"Has the planned stop date passed with no documented reason to continue?"},{"kind":"stop_date_check","offset_hours":240.0,"why":"Second stop date check."},{"kind":"stop_date_check","offset_hours":336.0,"why":"Prolonged therapy beyond two weeks is a documented stewardship target."}],"safety":["Every recommendation is a draft requiring licensed pharmacist approval.","The agent never prescribes, never changes an order, and never recommends a dose.","All data is synthetic. No real patient information is used at any point.","Scope is organism-to-drug appropriateness only, which is checkable against a result."]}