Faculté de Médecine, Département Universitaire de Médecine Générale, Université Nice-Sophia Antipolis, 28 Avenue de Valombrose, 06107, Nice Cedex 2, France.
Eur J Clin Microbiol Infect Dis. 2013 May;32(5):627-36. doi: 10.1007/s10096-012-1786-4. Epub 2012 Dec 8.
The purpose of this investigation was to assess the impact of selective reporting of antibiotic susceptibility data on the appropriateness of intended documented antibiotic prescriptions in urinary tract infections (UTIs) among residents training in general practice. We conducted a randomised-controlled case-vignette study in three French universities using a questionnaire with four UTI vignettes. In each university, residents were randomly allocated to two groups: a control group with usual full-length reporting of antibiotic susceptibility data (25 antibiotics) and an intervention group with selective reporting of antibiotic susceptibility data (2 to 4 antibiotics only). 326/611 residents (53 %) participated in the survey, 157/305 (52 %) in the intervention group and 169/306 (55 %) in the control group. For all four UTI scenarios, selective reporting of antibiotic susceptibility data significantly improved the appropriateness of antibiotic prescriptions (absolute increase ranging from 7 to 41 %, depending on the vignette). The variety of antibiotic prescriptions was reduced in the intervention group, and cephalosporins and fluoroquinolones were less often prescribed. Among 325 respondents, 124 (38 %) declared being either not really or not at all at ease with antibiotic susceptibility data, whereas 112/157 (71 %) of the residents in the intervention group declared that selective reporting of antibiotic susceptibility data made their antibiotic choice easier. Selective reporting of antibiotic susceptibility data could be a promising strategy to improve antibiotic use in UTIs, as part of a multi-faceted antibiotic stewardship programme. Microbiology laboratories should be aware that they can have a significant influence on antibiotic use.
本研究旨在评估抗生素药敏数据选择性报告对实习医生记录的尿路感染（UTI）中预期的、有文件记录的抗生素处方的适当性的影响。我们在法国的三所大学开展了一项随机对照病例对照研究，使用了一份包含四个 UTI 病例的问卷。在每所大学，实习医生被随机分为两组：对照组接受完整的抗生素药敏数据报告（25 种抗生素），干预组接受选择性抗生素药敏数据报告（仅报告 2-4 种抗生素）。共有 611 名实习医生中的 326 名（53%）参与了调查，其中干预组 157 名（52%），对照组 169 名（55%）。在所有四个 UTI 场景中，选择性报告抗生素药敏数据都显著提高了抗生素处方的适当性（绝对增加幅度从 7%到 41%不等，取决于病例）。干预组的抗生素处方种类减少，头孢菌素类和氟喹诺酮类药物的使用频率降低。在 325 名回答者中，有 124 名（38%）表示对抗生素药敏数据要么不太适应，要么完全不适应，而在干预组的 157 名医生中，有 112 名（71%）表示选择性报告抗生素药敏数据使他们的抗生素选择更容易。选择性报告抗生素药敏数据可能是改善 UTI 中抗生素使用的一种很有前途的策略，可作为多方面抗生素管理计划的一部分。微生物学实验室应该意识到，他们可以对抗生素的使用产生重大影响。
