Abstract：
OBJECTIVE: The use of selective reporting of antibiotic susceptibility testing (AST) results is a recommended antimicrobial stewardship strategy to improve the appropriateness of antibiotic prescriptions. We conducted a large, pragmatic, prospective, multicentre, controlled (selective reporting versus complete reporting) before-after intervention study to assess the impact of selective reporting of AST results for Escherichia coli-positive urine cultures on the prescription of broad-spectrum antibiotics carrying a higher risk of selection of resistance (i.e. amoxicillin-clavulanate, third-generation cephalosporins, and quinolones) in the outpatient setting. We also looked for possible unintended clinical consequences of the intervention leading to consultations and/or hospitalizations.
METHODS: We compared two groups of laboratories located in a French region. We collected data from the health insurance databases before (2017) and after the implementation of the intervention (2019). The primary outcome was the prescription proportion of broad-spectrum antibiotics.
RESULTS: We included 42,956 Escherichia coli-positive urine cultures with AST. The decrease in the proportion of broad-spectrum antibiotic prescriptions between 2017 and 2019 was significantly higher for selective reporting of AST, attributable to a decrease in the prescription proportion of third-generation cephalosporins (-8.5% for selective reporting versus -0.1% for complete reporting, p < 0.001). This impact was more marked for targeted therapy and female patients. Requests from clinicians for the complete reporting of AST results were infrequent (1.2% of all the selective AST results reported in 2019). No unintended consequences were observed.
CONCLUSIONS: The results showed a positive impact of the selective reporting of AST results, but room for improvement is still important.
METHODS: We compared two groups of laboratories located in a French region. We collected data from the health insurance databases before (2017) and after the implementation of the intervention (2019). The primary outcome was the prescription proportion of broad-spectrum antibiotics.
RESULTS: We included 42,956 Escherichia coli-positive urine cultures with AST. The decrease in the proportion of broad-spectrum antibiotic prescriptions between 2017 and 2019 was significantly higher for selective reporting of AST, attributable to a decrease in the prescription proportion of third-generation cephalosporins (-8.5% for selective reporting versus -0.1% for complete reporting, p < 0.001). This impact was more marked for targeted therapy and female patients. Requests from clinicians for the complete reporting of AST results were infrequent (1.2% of all the selective AST results reported in 2019). No unintended consequences were observed.
CONCLUSIONS: The results showed a positive impact of the selective reporting of AST results, but room for improvement is still important.
摘要：
目的：使用选择性报告抗生素药敏试验（AST）结果是推荐的抗菌药物管理策略，以提高抗生素处方的适当性。我们进行了大规模的，务实,prospective,多中心,对照（选择性报告与完整报告）干预前后研究，以评估选择性报告大肠杆菌阳性尿液培养物的AST结果对具有更高选择耐药性风险的广谱抗生素处方的影响（即阿莫西林-克拉维酸，第三代头孢菌素,和喹诺酮类药物)在门诊环境中。我们还寻找干预可能导致咨询和/或住院的意外临床后果。
方法：我们比较了位于法国地区的两组实验室。我们在干预措施实施之前（2017年）和之后（2019年）从健康保险数据库中收集数据。主要结果是广谱抗生素的处方比例。
结果：我们纳入了42,956例含AST的大肠杆菌阳性尿液培养物。2017年至2019年广谱抗生素处方比例下降明显高于选择性报告AST，归因于第三代头孢菌素的处方比例下降（选择性报告为-8.5％，而完整报告为-0.1％，p<0.001)。这种影响对于靶向治疗和女性患者更为明显。临床医生要求完整报告AST结果的要求很少见（占2019年报告的所有选择性AST结果的1.2％）。没有观察到意外后果。
结论：结果显示选择性报告AST结果具有积极影响，但是改进的空间仍然很重要。
方法：我们比较了位于法国地区的两组实验室。我们在干预措施实施之前（2017年）和之后（2019年）从健康保险数据库中收集数据。主要结果是广谱抗生素的处方比例。
结果：我们纳入了42,956例含AST的大肠杆菌阳性尿液培养物。2017年至2019年广谱抗生素处方比例下降明显高于选择性报告AST，归因于第三代头孢菌素的处方比例下降（选择性报告为-8.5％，而完整报告为-0.1％，p<0.001)。这种影响对于靶向治疗和女性患者更为明显。临床医生要求完整报告AST结果的要求很少见（占2019年报告的所有选择性AST结果的1.2％）。没有观察到意外后果。
结论：结果显示选择性报告AST结果具有积极影响，但是改进的空间仍然很重要。
