Impact of selective reporting of antibiotic susceptibility testing results for urinary tract infections in the outpatient setting: a prospective controlled before-after intervention study
Maïa Simon, Sébastien Fougnot, Patrice De Monchy, Alain Duda, Nathalie Thilly, C. Pulcini, Aurélie Bocquier, Alexandre Charmillon, Virginie Chopard, Marion Delpuech, A. Fagot‐Campagna, Joëlle Kivits, Gaëlle Le Dref, Alain Lozniewski, Amandine Luc, Violaine Mauffrey, Christian Rabaud, Emmanuelle Varon
Abstract
OBJECTIVES: 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. DISCUSSION: The results showed a positive impact of the selective reporting of AST results, but room for improvement is still important.