Selective reporting of antibiotic susceptibility testing results: a promising antibiotic stewardship tool

Tebano, Gianpiero; Mouelhi, Yosra; Zanichelli, Veronica; Charmillon, Alexandre; Fougnot, Sébastien; Lozniewski, Alain; Thilly, Nathalie; Pulcini, Céline

doi:10.1080/14787210.2020.1715795

Cited by 28 publications

(15 citation statements)

References 30 publications

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“…Selective reporting of antibiotic susceptibility testing results has been described as a promising antibiotic stewardship tool to reduce inappropriate antibiotic prescriptions [ 4 , 5 , 7 ]. In the specific case of infections due to P. aeruginosa, this easy-to-implement strategy should be promoted to reduce meropenem over-prescriptions, regardless of the size of the hospital and the availability of IDs consultations.…”

Section: Discussionmentioning

confidence: 99%

Impact of selective reporting of antibiotic susceptibility testing results on meropenem prescriptions for the treatment of Pseudomonas aeruginosa infections after 2020 EUCAST criteria update: an observational study in a university hospital

Munting

Damas

Viala

et al. 2022

Antimicrob Resist Infect Control

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Background We previously reported an increase in meropenem prescriptions for Pseudomonas aeruginosa infections in our hospital after the implementation of the 10th version of the EUCAST breakpoints table for P. aeruginosa in January 2020. As a consequence, antibiotic susceptibility testing results were adapted by masking meropenem for P. aeruginosa isolates susceptible to either ceftazidime, cefepime or piperacillin-tazobactam. We aimed to assess the changes in meropenem prescriptions after the implementation of the selective reporting. Methods In this retrospective single-centre observational study, we analysed antimicrobial therapies prescribed for P. aeruginosa infections after the susceptibility testing results have been made available over three periods: “before EUCAST update”, “after EUCAST update without selective reporting” and “after EUCAST update with selective reporting”, at Lausanne University Hospital, Switzerland. We collected epidemiological, microbiological and clinical data. The primary outcome was the prescription of meropenem to treat P. aeruginosa infections after the release of susceptibility testing results. Secondary outcomes were the use of increased dosage of non-meropenem anti-pseudomonal drugs, and IDs’ consultations rates after the release of susceptibility testing results. Results Among the 457 patients included, 65 (14.2%) received meropenem: 5/148 (3.4%) before EUCAST update, 51/202 (25.3%) after EUCAST update without selective reporting, and 9/107 (8.4%) after EUCAST update with selective reporting. Supervision and counselling from IDs as well as the use of increased dosages of non-carbapenem antibiotics increased in both periods after EUCAST update, compared to the first period, respectively: 40.5% (60/148) versus 61.4% (124/202) versus 51.4% (55/107) (P < 0.001), and 57.9% (84/148) versus 91.1% (183/202) versus 90.7% (97/107) (P < 0.001). Conclusions Selective reporting of antibiotic susceptibility testing results might decrease unnecessary meropenem prescriptions for the treatment of P. aeruginosa infections and could be part of multimodal antibiotic stewardship interventions.

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Section: Discussionmentioning

confidence: 99%

Impact of selective reporting of antibiotic susceptibility testing results on meropenem prescriptions for the treatment of Pseudomonas aeruginosa infections after 2020 EUCAST criteria update: an observational study in a university hospital

Munting

Damas

Viala

et al. 2022

Antimicrob Resist Infect Control

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“…The success of this intervention was further amplified using in-person and written education to ensure clinician adoption and understanding. Similar studies suggest that microbiology laboratory nudges and selective reporting effectively alter antimicrobial prescribing and optimize diagnostic test use [ 40 , 41 ]. Finally, for some diagnostics, evidence-based guidelines or protocols used at the point of care may help apply the microbiology results to clinical decision making and is therefore supported in the American Society for Clinical Pathology’s “Choosing Wisely” recommendations [ 42 ].…”

Section: Considerations For Post-analytic Diagnostic Stewardship Inte...mentioning

confidence: 94%

Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement

2022

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Diagnostic stewardship aims to deliver the right test to the right patient at the right time and is optimally combined with antimicrobial stewardship to allow for the right interpretation to translate into the right antimicrobial at the right time. Laboratorians, physicians, pharmacists, and other healthcare providers have an opportunity to improve the effectiveness of diagnostics through collaborative activities around pre-analytical and post-analytical periods of diagnostic testing. Additionally, special considerations should be given to measuring the effectiveness of diagnostics over time. Herein, we perform a narrative review of the literature on these potential optimization opportunities and the temporal factors that can yield changes in diagnostic effectiveness. Our objective is to inform on these considerations to ensure enhanced value through improved implementation and measurement of effectiveness for local stakeholder metrics and/or clinical outcomes research.

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“…When the antimicrobial susceptibility results of patients are reported, a selective report of the specific antimicrobial susceptibility , is more helpful than providing the susceptibility results of all the antimicrobials tested, for choosing appropriate antimicrobial agents and controlling antimicrobial agent use [ 83 84 ], particularly in patients with uncomplicated UTIs [ 85 ]. A sequential report can be provided, which lists the susceptibility result of the second antimicrobial agent if the organism is resistant to the primary antimicrobial agent [ 1 ].…”

Section: Recommended Guidelines For Each Key Questionmentioning

confidence: 99%

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

et al. 2021

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These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.

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Selective reporting of antibiotic susceptibility testing results: a promising antibiotic stewardship tool

Cited by 28 publications

References 30 publications

Impact of selective reporting of antibiotic susceptibility testing results on meropenem prescriptions for the treatment of Pseudomonas aeruginosa infections after 2020 EUCAST criteria update: an observational study in a university hospital

Impact of selective reporting of antibiotic susceptibility testing results on meropenem prescriptions for the treatment of Pseudomonas aeruginosa infections after 2020 EUCAST criteria update: an observational study in a university hospital

Diagnostic Stewardship as a Team Sport: Interdisciplinary Perspectives on Improved Implementation of Interventions and Effect Measurement

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

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