Clinical use of rifampicin during routine reporting of rifampicin susceptibilities: a lesson in selective reporting of antimicrobial susceptibility data

Steffee, C. H.; Morrell, Robert; Wasilauskas, Benedict L.

doi:10.1093/jac/40.4.595

Cited by 28 publications

(14 citation statements)

References 5 publications

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“…After exclusion, 15 studies met eligibility for inclusion in the scoping review. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Figure 1 shows the flow diagram for study inclusion.…”

Section: Resultsmentioning

confidence: 99%

Nudging In MicroBiology Laboratory Evaluation (NIMBLE): A scoping review

Langford

Leung

Haj

et al. 2019

Infect. Control Hosp. Epidemiol.

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Background:Nudging in microbiology is an antimicrobial stewardship strategy to influence decision making through the strategic reporting of microbiology results while preserving prescriber autonomy. The purpose of this scoping review was to identify the evidence that demonstrates the effectiveness of nudging strategies in susceptibility result reporting to improve antimicrobial use.Methods:A search for studies in Ovid MEDLINE, Embase, PsycINFO, and All EBM Reviews was conducted. All simulated and vignette studies were excluded. Two independent reviewers were used throughout screening and data extraction.Results:Of a total of 1,346 citations screened, 15 relevant studies were identified. Study types included pre- and postintervention (n = 10), retrospective cohort (n = 4), and a randomized controlled trial (n = 1). Most studies were performed in acute-care settings (n = 13), and the remainder were in primary care (n = 2). Most studies used a strategy to alter the default antibiotic choices on the antibiotic report. All studies reported at least 1 outcome of antimicrobial use: utilization (n = 9), appropriateness (n = 7), de-escalation (n = 2), and cost (n = 1). Moreover, 12 studies reported an overall benefit in antimicrobial use outcomes associated with nudging, and 4 studies evaluated the association of nudging strategy with subsequent antimicrobial resistance, with 2 studies noting overall improvement.Conclusions:The number of heterogeneous studies evaluating the impact of applying nudging strategies to susceptibility result reports is small; however, most strategies do show promise in altering prescriber’s antibiotic selection. Selective and cascade reporting of targeted agents in a hospital setting represent the majority of current research. Gaps and opportunities for future research identified from our scoping review include performing prospective randomized controlled trials and evaluating other approaches aside from selective reporting.

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Section: Resultsmentioning

confidence: 99%

Nudging In MicroBiology Laboratory Evaluation (NIMBLE): A scoping review

Langford

Leung

Haj

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…The guideline development group recommends the use of selective reporting of susceptibility testing results with respect to choice and number of antimicrobial agents depending on pathogen, local susceptibility data and existing therapy guidelines, with the objective of supporting guideline-adherent antibiotic therapy [ 1 , 6 , 372 ]. Two methodologically different interrupted time-series analyses indicate that selective antibiotic susceptibility reporting can influence prescribing behaviour [ 373 , 374 ]. Additional reporting, providing information on major resistance mechanisms, on contamination or colonisation according to pathogen and pathogen quantity, or information on diagnostic and therapeutic guidelines can support ABS measures.…”

Section: Recommendations Of the Guidelinementioning

confidence: 99%

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

et al. 2016

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IntroductionIn the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute.Materials and methodsA structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development.ConclusionThe guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.

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“…Guiding the clinician using the antibiogram as an AMS tool could reach many more patients in a very cost-effective way. Selective antibiotic reporting is recommended by most AMS guidelines [1-3, 12, 20, 21], although the evidence is very scant: very few studies have proved a signi cant effect on antibiotic consumption for urinary tract infections or infections due to gram-negative pathogens [24][25][26][27][28] or for the use of rifampicin [29]. To our knowledge there are no studies on frequently occurring and often severe S. aureus infections.…”

Section: Discussionmentioning

confidence: 99%

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

Lestin-Bernstein¹,

Harberg²,

Schumacher³

et al. 2020

Preprint

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Background:Antimicrobial stewardship (AMS) strategies worldwide focus on optimised antibiotic use. 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/oral cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin; instead of reporting all tested antibiotics during the year before the intervention and in the reference clinic. The impact of the intervention was analysed by monitoring antibiotic consumption (recommended daily dose/100 occupied bed days: RDD/100 BD).Results:MSSA-antibiograms were reported for 2836 patients. Total use of narrow-spectrum beta-lactams more than doubled during the intervention (from 1.2 to 2.8 RDD/100 BD, P<0.001; P<0.001 compared to the reference clinic); the percentage of total antibiotic use increased from 2.6% to 6.2%. A slight, but significant increase in the use of trimethoprim-sulfamethoxazole was also observed (+ 0.37 RDD/100 BD).There was no decrease in antibiotics withdrawn from the antibiogram, probably as a consequence of their wide use for indications other than S. aureus infections.Conclusions:As narrow-spectrum beta-lactams are not widely used for other infections, there is a strong indication that selective reporting guided clinicians to optimised antibiotic therapy of S. aureus infections.As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

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Clinical use of rifampicin during routine reporting of rifampicin susceptibilities: a lesson in selective reporting of antimicrobial susceptibility data

Cited by 28 publications

References 5 publications

Nudging In MicroBiology Laboratory Evaluation (NIMBLE): A scoping review

Nudging In MicroBiology Laboratory Evaluation (NIMBLE): A scoping review

Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases

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

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