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 repo...
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | Antimicrobial Resistance and Infection Control |
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| Online Access: | https://doi.org/10.1186/s13756-021-01021-7 |
| _version_ | 1831671649149124608 |
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| author | Franka Lestin-Bernstein Ramona Harberg Ingo Schumacher Lutz Briedigkeit Oliver Heese Kristina Biedermann |
| author_facet | Franka Lestin-Bernstein Ramona Harberg Ingo Schumacher Lutz Briedigkeit Oliver Heese Kristina Biedermann |
| author_sort | Franka Lestin-Bernstein |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T23:38:33Z |
| format | Article |
| id | doaj.art-644482b2249c45259f538d95fac9a16b |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-19T23:38:33Z |
| publishDate | 2021-11-01 |
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| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-644482b2249c45259f538d95fac9a16b2022-12-21T20:01:30ZengBMCAntimicrobial Resistance and Infection Control2047-29942021-11-0110111310.1186/s13756-021-01021-7Staphylococcus 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 reportingFranka Lestin-Bernstein0Ramona Harberg1Ingo Schumacher2Lutz Briedigkeit3Oliver Heese4Kristina Biedermann5Department for Clinical Hygiene and Infectiology, Helios Clinics of Schwerin - University Campus of MSH Medical School HamburgCentral Pharmacy, Helios Clinics of Schwerin - University Campus of MSH Medical School HamburgAnesthesiology and Intensive Care Medicine, Helios Clinics of Schwerin - University Campus of MSH Medical School HamburgInstitute for Laboratory and Transfusion Medicine, Helios Clinics of Schwerin - University Campus of MSH Medical School HamburgNeurosurgery and Spinal Surgery, Helios Clinics of Schwerin - University Campus of MSH Medical School HamburgDepartment for Clinical Hygiene and Infectiology, Helios Clinics of Schwerin - University Campus of MSH Medical School HamburgAbstract 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.https://doi.org/10.1186/s13756-021-01021-7Antimicrobial stewardship (AMS)Staphylococcus aureus infectionSelective reporting of susceptibility testingSelective antibiogramRecommended daily dose (RDD)Days of therapy (DOT) |
| spellingShingle | Franka Lestin-Bernstein Ramona Harberg Ingo Schumacher Lutz Briedigkeit Oliver Heese Kristina Biedermann 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 Antimicrobial Resistance and Infection Control Antimicrobial stewardship (AMS) Staphylococcus aureus infection Selective reporting of susceptibility testing Selective antibiogram Recommended daily dose (RDD) Days of therapy (DOT) |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Antimicrobial stewardship (AMS) Staphylococcus aureus infection Selective reporting of susceptibility testing Selective antibiogram Recommended daily dose (RDD) Days of therapy (DOT) |
| url | https://doi.org/10.1186/s13756-021-01021-7 |
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