Langford B J, Seah J, Chan A, Downing M, Johnstone J, Matukas L M
St. Joseph's Health Centre, Toronto, Ontario, Canada
St. Joseph's Health Centre, Toronto, Ontario, Canada.
J Clin Microbiol. 2016 Sep;54(9):2343-7. doi: 10.1128/JCM.00950-16. Epub 2016 Jul 6.
The objective of this study was to determine the impact of selective susceptibility reporting on ciprofloxacin utilization and Gram-negative susceptibility to ciprofloxacin in a hospital setting. Historically at our institution, the microbiology laboratory practice was to report ciprofloxacin susceptibility for all Enterobacteriaceae regardless of susceptibility to other agents. A selective reporting policy was implemented which involved the suppression of ciprofloxacin susceptibility to Enterobacteriaceae when there was lack of resistance to the antibiotics on the Gram-negative panel. Ciprofloxacin utilization (measured in defined daily doses [DDD] per 1,000 patient days) was collected before and after the intervention and compared to moxifloxacin, trimethoprim-sulfamethoxazole, nitrofurantoin, and amoxicillin-clavulanate. Monthly susceptibility of Pseudomonas aeruginosa and Escherichia coli to ciprofloxacin was tabulated. An interrupted time series analysis using segmented regression was performed. The mean monthly ciprofloxacin utilization decreased from 87 (95% CI, 83.7 to 91.2) to 39 (95% CI, 35.0 to 44.0) DDD per 1,000 patient days before and after the implementation of selective reporting, respectively. There was an immediate and sustained reduction in ciprofloxacin usage at 1, 3, 6, 12, and 24 months postintervention (P < 0.001). A compensatory increase in amoxicillin-clavulanate use was noted starting at 6 months postintervention and persisted for the study period (P < 0.027). Susceptibility of E. coli, but not that of P. aeruginosa, to ciprofloxacin was higher than predicted starting 12 months after the intervention (P < 0.05). In conclusion, selective reporting of ciprofloxacin susceptibly may be a useful intervention to reduce targeted antimicrobial utilization and improve Gram-negative susceptibility to ciprofloxacin. This approach should be considered as part of a broader multimodal antimicrobial stewardship program.
本研究的目的是确定在医院环境中，选择性药敏报告对环丙沙星使用情况以及革兰氏阴性菌对环丙沙星敏感性的影响。在我们机构的历史上，微生物实验室的做法是，无论对其他药物的敏感性如何，都报告所有肠杆菌科细菌对环丙沙星的敏感性。实施了一项选择性报告政策，即在革兰氏阴性菌药敏试验中对其他抗生素无耐药性时，不报告肠杆菌科细菌对环丙沙星的敏感性。在干预前后收集环丙沙星的使用情况（以每1000个患者日的限定日剂量[DDD]衡量），并与莫西沙星、甲氧苄啶-磺胺甲恶唑、呋喃妥因和阿莫西林-克拉维酸进行比较。每月将铜绿假单胞菌和大肠杆菌对环丙沙星的敏感性制成表格。采用分段回归进行中断时间序列分析。在实施选择性报告前后，每1000个患者日的环丙沙星平均月使用量分别从87（95%CI，83.7至91.2）降至39（95%CI，35.0至44.0）DDD。在干预后1、3、6、12和24个月，环丙沙星的使用量立即且持续下降（P<0.001）。从干预后6个月开始，阿莫西林-克拉维酸的使用量出现代偿性增加，并在研究期间持续存在（P<0.027）。从干预后12个月开始，大肠杆菌对环丙沙星的敏感性高于预期，但铜绿假单胞菌对环丙沙星的敏感性并非如此（P<0.05）。总之，选择性报告环丙沙星敏感性可能是一种有用的干预措施，可减少目标抗菌药物的使用，并提高革兰氏阴性菌对环丙沙星的敏感性。这种方法应被视为更广泛的多模式抗菌药物管理计划的一部分。
