Wu Hsiu, Lutgring Joseph D, McDonald L Clifford, Webb Amy, Fields Virgie, Blum Laura, Mojica Malissa, Edwards Jonathan, Soe Minn Minn, Pollock Daniel A
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lantana Consulting Group, Inc, Thetford, Vermont, USA.
Microbiol Spectr. 2023 Jan 31;11(2):e0164622. doi: 10.1128/spectrum.01646-22.
Selective or cascade reporting (SR/CR) of antimicrobial susceptibility testing (AST) results is a strategy for antimicrobial stewardship. SR/CR is often achieved by suppressing AST results of secondary drugs in electronic laboratory reports. We assessed the extent of SR/CR and its impact on cumulative antibiograms (CAs) in a large cohort of U.S. hospitals submitting AST data to the CDC's National Healthcare Safety Network (NHSN) through electronic data exchange. The NHSN calls for hospitals to extract AST data from their electronic systems. We analyzed the AST reported for Escherichia coli (blood and urine) and Staphylococcus aureus (blood and lower respiratory tract [LRT]) isolates from April 2020 to March 2021, used AST reporting patterns to assign SR/CR reporting status for hospitals, and compared their CAs. Sensitivity analyses were done to account for those potentially extracted complete data. At least 35% and 41% of the hospitals had AST data that were suppressed in more than 20% blood isolates for E. coli and S. aureus isolates, respectively. At least 63% (blood) and 50% (urine) routinely reported ciprofloxacin or levofloxacin for E. coli isolates; and 60% (blood) and 59% (LRT) routinely reported vancomycin for S. aureus isolates. The distribution of CAs for many agents differed between high SR/CR and low- or non-SR/CR hospitals. Hospitals struggled to obtain complete AST data through electronic data exchange because of data suppression. Use of SR/CR can bias CAs if incomplete data are used. Technical solutions are needed for extracting complete AST results for public health surveillance. This study is the first to assess the extent of using selective and/or cascade antimicrobial susceptibility reporting for antimicrobial stewardship among U.S. hospitals and its impact on cumulative antibiograms in the context of electronic data exchange for national antimicrobial resistance surveillance.
抗菌药物敏感性试验（AST）结果的选择性或级联报告（SR/CR）是一种抗菌药物管理策略。SR/CR通常通过在电子实验室报告中抑制二线药物的AST结果来实现。我们评估了通过电子数据交换向美国疾病控制与预防中心（CDC）的国家医疗安全网络（NHSN）提交AST数据的大量美国医院中SR/CR的程度及其对累积抗菌谱（CA）的影响。NHSN要求医院从其电子系统中提取AST数据。我们分析了2020年4月至2021年3月期间从大肠杆菌（血液和尿液）和金黄色葡萄球菌（血液和下呼吸道[LRT]）分离株报告的AST，利用AST报告模式为医院确定SR/CR报告状态，并比较它们的CA。进行敏感性分析以考虑那些可能提取的完整数据。至少35%和41%的医院分别在超过20%的大肠杆菌和金黄色葡萄球菌血液分离株中存在AST数据被抑制的情况。至少63%（血液）和50%（尿液）的医院常规报告针对大肠杆菌分离株的环丙沙星或左氧氟沙星；60%（血液）和59%（LRT）的医院常规报告针对金黄色葡萄球菌分离株的万古霉素。许多药物的CA分布在高SR/CR医院与低SR/CR或非SR/CR医院之间存在差异。由于数据抑制，医院难以通过电子数据交换获得完整的AST数据。如果使用不完整的数据，SR/CR的使用可能会使CA产生偏差。为了公共卫生监测，需要技术解决方案来提取完整的AST结果。本研究首次评估了美国医院在抗菌药物管理中使用选择性和/或级联抗菌药物敏感性报告的程度及其在国家抗菌药物耐药性监测电子数据交换背景下对累积抗菌谱的影响。
