Impact of cascade reporting of antimicrobial susceptibility on fluoroquinolone and meropenem consumption at a Veterans' Affairs medical center

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.

Fig. 1 A.

Cascade reporting algorithm for antimicrobial susceptibility reporting for Enterobacteriaceae.

Fig. 1 B.

Cascade reporting algorithm for antimicrobial susceptibility reporting for Pseudomonas aeruginosa.

Fig. 2.

Interrupted time series analysis depicting the slope before and after the cascade reporting implementation periods for ciprofloxacin, levofloxacin, moxifloxacin, and meropenem. Antimicrobial use is reported across all units in average days of therapy (DOTs) per 1,000 days present. Note. CR, cascade reporting. *For moxifloxacin, medians are reported because data were not normally distributed.