Author:
Munting Aline,Damas José,Viala Benjamin,Prod’hom Guy,Guery Benoit,Senn Laurence
Abstract
Abstract
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.
Publisher
Springer Science and Business Media LLC
Subject
Pharmacology (medical),Infectious Diseases,Microbiology (medical),Public Health, Environmental and Occupational Health
Reference7 articles.
1. EUCAST. Clinical breakpoints and dosing of antibiotics; 20202020. Available from: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_10.0_Breakpoint_Tables.pdf.
2. Munting A, Regina J, Damas J, Lhopitallier L, Kritikos A, Guery B, et al. Impact of 2020 EUCAST criteria on meropenem prescription for the treatment of Pseudomonas aeruginosa infections: an observational study in a university hospital. Clin Microbiol Infect. 2022;28(4):558–63.
3. Liao S, Rhodes J, Jandarov R, DeVore Z, Sopirala MM. Out of sight-out of mind: impact of cascade reporting on antimicrobial usage. Open Forum Infect Dis. 2020;7(2):ofaa002.
4. Tebano G, Mouelhi Y, Zanichelli V, Charmillon A, Fougnot S, Lozniewski A, et al. Selective reporting of antibiotic susceptibility testing results: a promising antibiotic stewardship tool. Expert Rev Anti Infect Ther. 2020;18(3):251–62.
5. Pulcini C, Tebano G, Mutters NT, Tacconelli E, Cambau E, Kahlmeter G, et al. Selective reporting of antibiotic susceptibility test results in European countries: an ESCMID cross-sectional survey. Int J Antimicrob Agents. 2017;49(2):162–6.