Restrictive reporting of selected antimicrobial susceptibilities influences clinical prescribing

Abstract

Summary: Background: Cascade and restrictive reporting are useful strategies to enhance antibiotic stewardship programs. Methods: We combined both strategies to improve the prescribing of antibiotics aimed at Gram-negative infections. Results: For Enterobacter aerogenes, the susceptibility rates to amikacin increased from 10% to 100%; for third generation cephalosporins, these rates increased from 55% to 89%. The susceptibility rates of E. aerogenes to cefepime and piperacillin–tazobactam changed little, and the ampicillin susceptibility decreased from 30% in 2009 to 11% in 2010. For Proteus mirabilis, the susceptibility rates increased for third-generation cephalosporins (48% vs. 92%) and piperacillin–tazobactam (10% vs. 98%), with minimal changes for cefepime (96% vs. 93%), ampicillin (69% vs. 73%) and amikacin (96% vs. 84%). For Pseudomonas aeruginosa, the susceptibility rates improved slightly for third-generation cephalosporins (81% vs. 91%) but reduced for piperacillin–tazobactam (99% vs. 59%). Hospital-acquired Clostridium difficile infections decreased from 0.11 to 0.07 per 1000 patient days. Conclusions: Selective reporting helps physicians choose the most appropriate antibiotics for their patients within a stewardship program, with reduced C. difficile infection. Keywords: Antibiotic stewardship, Restrictive reporting, DDD, Defined daily doses, Antimicrobial resistance