Liao Siyun, Rhodes Judith, Jandarov Roman, DeVore Zachary, Sopirala Madhuri M
Department of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
Department of Pathology, University of College of Medicine, Cincinnati, Ohio, USA.
Open Forum Infect Dis. 2020 Jan 8;7(2):ofaa002. doi: 10.1093/ofid/ofaa002. eCollection 2020 Feb.
There is a paucity of data evaluating the strategy of suppressing broader-spectrum antibiotic susceptibilities on utilization. Cascade reporting (CR) is a strategy of reporting antimicrobial susceptibility test results in which secondary (eg, broader-spectrum, costlier) agents may only be reported if an organism is resistant to primary agents within a particular drug class. Our objective was to evaluate the impact of ceftriaxone-based cascade reporting on utilization of cefepime and clinical outcomes in patients with ceftriaxone-susceptible and clinical cultures.
We compared post-CR (July 2014-June 2015) with baseline (July 2013-June 2014), evaluating utilization of cefepime, cefazolin, ceftriaxone, ampicillin derivatives, fluoroquinolones, piperacillin/tazobactam, ertapenem, and meropenem; new infection; and length of stay (LOS) after the positive culture, 30-day readmission, and in-hospital all-cause mortality.
Mean days of therapy (DOT) among patients who received any antibiotic for cefepime decreased from 1.229 days during the baseline period to 0.813 days post-CR (adjusted relative risk, 0.668; < .0001). Mean DOT of ceftriaxone increased from 0.864 days to 0.962 days, with an adjusted relative risk of 1.113 ( = .004). No significant differences were detected in other antibiotics including ertapenem and meropenem, demonstrating the direct association of the decrease in cefepime utilization with CR based on ceftriaxone susceptibility. Average LOS in the study population decreased from 14.139 days to 10.882 days from baseline to post-CR and was found to be statistically significant ( < .0001).
In conclusion, we demonstrated significant association of decreased cefepime utilization with the implementation of a CR based on ceftriaxone susceptibility. We demonstrated the safety of deescalation, with LOS being significantly lower during the post-CR period than in the baseline period, with no change in in-hospital mortality.
评估抑制更广泛谱抗生素敏感性策略对其使用情况影响的数据较少。级联报告（CR）是一种报告抗菌药物敏感性试验结果的策略，其中只有当某一微生物对特定药物类别中的主要药物耐药时，才可能报告次要（如更广泛谱、更昂贵）药物。我们的目的是评估基于头孢曲松的级联报告对头孢吡肟使用情况以及头孢曲松敏感且有临床培养结果的患者临床结局的影响。
我们将CR实施后（2014年7月至2015年6月）与基线期（2013年7月至2014年6月）进行比较，评估头孢吡肟、头孢唑林、头孢曲松、氨苄西林衍生物、氟喹诺酮类、哌拉西林/他唑巴坦、厄他培南和美罗培南的使用情况；新发感染；以及阳性培养结果后的住院时间（LOS）、30天再入院率和院内全因死亡率。
接受任何抗生素治疗的患者中，头孢吡肟的平均治疗天数（DOT）从基线期的1.229天降至CR实施后的0.813天（调整相对风险，0.668；P<0.0001）。头孢曲松的平均DOT从0.864天增加到0.962天，调整相对风险为1.113（P = 0.004）。在包括厄他培南和美罗培南在内的其他抗生素方面未检测到显著差异，这表明头孢吡肟使用量的减少与基于头孢曲松敏感性的CR直接相关。研究人群的平均LOS从基线期的14.139天降至CR实施后的10.882天，且差异具有统计学意义（P<0.0001）。
总之，我们证明了头孢吡肟使用量的减少与基于头孢曲松敏感性的CR实施之间存在显著关联。我们证明了降阶梯治疗的安全性，CR实施后的LOS显著低于基线期，且院内死亡率无变化。
