Centre Hospitalier Émile Durkheim, Service de Médecine A, Epinal, France.
CHRU de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France.
Int J Antimicrob Agents. 2017 Aug;50(2):258-262. doi: 10.1016/j.ijantimicag.2017.01.040. Epub 2017 May 31.
Selective reporting of antibiotic susceptibility test (AST) results is a potential intervention for laboratory-based antibiotic stewardship. The aim of this study was to assess the impact of AST reporting on the appropriateness of antibiotics selected by French general practitioners for urinary tract infections (UTIs). A randomised controlled case-vignette study in a region of northeast France surveyed general practitioners between July and October 2015 on treatment of four clinical cases of community-acquired Escherichia coli UTIs (two cases of complicated cystitis, one of acute pyelonephritis and one male UTI). In Group A, selective reporting of AST results was used for the first two cases and complete reporting for the other two cases; these were reversed in Group B. The overall participation rate was 131/198 (66.2%). Provision of selective AST results significantly increased the rate of adherence to national guidelines for first-line antibiotic treatment in Cases 1, 3 and 4 by 22.4% (55.2% vs. 32.8%, P = 0.01), 67.5% (75.0% vs. 7.5%, P <0.001) and 36.3% (45.3% vs. 9.0%, P <0.001), respectively. The improvement in compliance was not significant for Case 2. Prescriptions of amoxicillin-clavulanic acid, fluoroquinolones and cephalosporins decreased by 25.0% to 45.0%, depending on the clinical vignette. Most (106/131, 81.0%) participants favoured the routine use of selective reporting of AST results. In conclusion, selective reporting of AST results seems to improve antibiotic prescribing practices in primary care, and may be considered a key element of antimicrobial stewardship programmes.
抗生素药敏试验（AST）结果的选择性报告是实验室抗生素管理的潜在干预措施。本研究旨在评估 AST 报告对法国全科医生治疗尿路感染（UTI）时选择抗生素的适当性的影响。2015 年 7 月至 10 月，在法国东北部的一个地区，一项随机对照病例对照研究调查了全科医生对 4 例社区获得性大肠埃希菌 UTI（2 例复杂性膀胱炎、1 例急性肾盂肾炎和 1 例男性 UTI）的治疗情况。在 A 组中，前两例采用选择性 AST 结果报告，后两例采用完全报告；在 B 组中则相反。总参与率为 131/198（66.2%）。提供选择性 AST 结果显著提高了第 1、3 和 4 例病例中一线抗生素治疗的国家指南的依从率，分别提高了 22.4%（55.2%比 32.8%，P=0.01）、67.5%（75.0%比 7.5%，P<0.001）和 36.3%（45.3%比 9.0%，P<0.001）。第 2 例病例的依从性改善不显著。根据临床病例，阿莫西林-克拉维酸、氟喹诺酮类和头孢菌素的处方减少了 25.0%至 45.0%。大多数（106/131，81.0%）参与者赞成常规使用 AST 结果的选择性报告。总之，AST 结果的选择性报告似乎改善了初级保健中的抗生素处方实践，可被视为抗菌药物管理计划的关键要素。
