Impact of selective reporting of antibiotic susceptibility test results on the appropriateness of antibiotics chosen by French general practitioners in urinary tract infections: a randomised controlled case-vignette study.
Fiche publication
Date publication
août 2017
Journal
International journal of antimicrobial agents
Auteurs
Membres identifiés du Cancéropôle Est :
Pr THILLY Nathalie
Tous les auteurs :
Bourdellon L, Thilly N, Fougnot S, Pulcini C, Henard S
Lien Pubmed
Résumé
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.
Mots clés
Adult, Aged, Anti-Bacterial Agents, therapeutic use, Antimicrobial Stewardship, Community-Acquired Infections, drug therapy, Escherichia coli Infections, drug therapy, Female, France, General Practitioners, Guideline Adherence, Humans, Male, Middle Aged, Primary Health Care, methods, Surveys and Questionnaires, Urinary Tract Infections, drug therapy
Référence
Int. J. Antimicrob. Agents. 2017 Aug;50(2):258-262