Staphylococcus aureus - selective reporting of antibiogram results and its impact on antibiotic use: Interventional study with a reference group on the effect of switching from non-selective to selective antibiotic reporting

Abstract

Background Antimicrobial stewardship (AMS) strategies worldwide focus on optimising the use of antibiotics. Selective susceptibility reporting is recommended as an effective AMS tool although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use. The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections. Methods This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin, instead of reporting all tested antibiotics. The impact of implementing selective reporting was analysed by monitoring total monthly antibiotic consumption in our hospital and in a reference hospital (recommended daily dose/100 occupied bed days: RDD/100 BD), as well as on an individual patient level by analysing days of therapy adjusted for bed days (DOT/ 100 BD) for patients with S. aureus bacteremia (SAB) and respectively skin and soft tissue infections (SSTI). Results MSSA-antibiograms were acquired for 2836 patients. The total use of narrow-spectrum beta-lactams more than doubled after implementing selective reporting (from 1.2 to 2.8 RDD/100 BD, P < 0.001). The use of intravenous flucloxacillin/cefazolin for SAB rose significantly from 52 to 75 DOT/100 BD (plus 42%), just as the use of oral cefalexin for SSTI (from 1.4 to 9.4 DOT/100 BD, from 3 to 17 of 85/88 patients). Considering the overall consumption, there was no decrease in antibiotics omitted from the antibiogram. This was probably due to their wide use for other infections. Conclusions As narrow-spectrum beta-lactams are not widely used for other infections, their increase in the overall consumption of the entire hospital was a strong indicator that selective reporting guided clinicians to an optimised antibiotic therapy of S. aureus infections. On a patient level, this assumption was verified by a significant improved treatment of S. aureus infections in the subgroups of SAB and SSTI. As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

Impact of Selective Reporting of Antibiotic Susceptibility Test Results on Antibiotic Use in Patients with Bloodstream Infection with Streptococcus pneumoniae

“…In this study, these two points were not present and selective reporting of antibiotic susceptibility test results led to a significantly higher use of ampicillin. Likewise, Lestin-Bernstein et al [ 9 ] reported a significantly higher use of narrow-spectrum penicillin after the implementation of selective reporting in BSI with Staphylococcus aureus . In this study, a comment on the microbiological report was also included, directing clinicians to the preferred choice of therapy; this possibly might have also contributed to the success of the intervention.…”

“…Clinical microbiology therefore is an essential part of antibiotic stewardship. Selective reporting of antibiotic susceptibility test results might facilitate pathogen-directed antibiotic therapy and thus be an important antibiotic stewardship intervention [7][8][9], which was also highlighted in the previously revised German guideline on the rational use of antibiotics in medicine [10]. The aim of this study was to analyse whether selective antibiotic susceptibility reporting resulted in more focused antibiotic therapy in patients with Streptococcus pneumoniae bloodstream infection (BSI).…”