Nicole C Vissichelli1,2, Christine M Orndahl3, Jane A Cecil1,2, Emily M Hill4, Matthew M Hitchcock2, Roy T Sabo3, Michael P Stevens1, Dan Tassone2, Leroy B Vaughan2, J Daniel Markley1,2. 1. Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia. 2. Department of Infectious Diseases, Hunter Holmes McGuire Veteran's Affairs Medical Center, Richmond, Virginia. 3. Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia. 4. Department of Pathology, Hunter Holmes McGuire Veteran's Affairs Medical Center, Richmond, Virginia.
Abstract
OBJECTIVE: To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption. DESIGN: A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumption before and after the implementation of cascade reporting. SETTING: A 399-bed, tertiary-care, Veterans' Affairs medical center. PARTICIPANTS: Antimicrobial consumption data across 8 inpatient units were extracted from the Center for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) antimicrobial use (AU) module from April 2017 through March 2019, reported as antimicrobial days of therapy (DOT) per 1,000 days present (DP). INTERVENTION: Cascade reporting is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow-spectrum agents. A multidisciplinary team developed cascade reporting algorithms for gram-negative bacteria based on local antibiogram and infectious diseases practice guidelines, aimed at restricting the use of fluoroquinolones and carbapenems. The algorithms were implemented in March 2018. RESULTS: Following the implementation of cascade reporting, mean monthly meropenem (P =.005) and piperacillin/tazobactam (P = .002) consumption decreased and cefepime consumption increased (P < .001). Ciprofloxacin consumption decreased by 2.16 DOT per 1,000 DP per month (SE, 0.25; P < .001). Clostridioides difficile rates did not significantly change. CONCLUSION: Ciprofloxacin consumption significantly decreased after the implementation of cascade reporting. Mean meropenem consumption decreased after cascade reporting was implemented, but we observed no significant change in the slope of consumption. cascade reporting may be a useful strategy to optimize antimicrobial prescribing.
OBJECTIVE: To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption. DESIGN: A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumption before and after the implementation of cascade reporting. SETTING: A 399-bed, tertiary-care, Veterans' Affairs medical center. PARTICIPANTS: Antimicrobial consumption data across 8 inpatient units were extracted from the Center for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) antimicrobial use (AU) module from April 2017 through March 2019, reported as antimicrobial days of therapy (DOT) per 1,000 days present (DP). INTERVENTION: Cascade reporting is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow-spectrum agents. A multidisciplinary team developed cascade reporting algorithms for gram-negative bacteria based on local antibiogram and infectious diseases practice guidelines, aimed at restricting the use of fluoroquinolones and carbapenems. The algorithms were implemented in March 2018. RESULTS: Following the implementation of cascade reporting, mean monthly meropenem (P =.005) and piperacillin/tazobactam (P = .002) consumption decreased and cefepime consumption increased (P < .001). Ciprofloxacin consumption decreased by 2.16 DOT per 1,000 DP per month (SE, 0.25; P < .001). Clostridioides difficile rates did not significantly change. CONCLUSION: Ciprofloxacin consumption significantly decreased after the implementation of cascade reporting. Mean meropenem consumption decreased after cascade reporting was implemented, but we observed no significant change in the slope of consumption. cascade reporting may be a useful strategy to optimize antimicrobial prescribing.
Authors: Katharina L van Santen; Jonathan R Edwards; Amy K Webb; Lori A Pollack; Erin O'Leary; Melinda M Neuhauser; Arjun Srinivasan; Daniel A Pollock Journal: Clin Infect Dis Date: 2018-07-02 Impact factor: 9.079
Authors: Y M Zou; Y Ma; J H Liu; J Shi; T Fan; Y Y Shan; H P Yao; Y L Dong Journal: Eur J Clin Microbiol Infect Dis Date: 2014-12-10 Impact factor: 3.267
Authors: Sarah Kabbani; Adam L Hersh; Daniel J Shapiro; Katherine E Fleming-Dutra; Andrew T Pavia; Lauri A Hicks Journal: Clin Infect Dis Date: 2018-06-18 Impact factor: 9.079