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.
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。