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

Published online by Cambridge University Press:  06 April 2021

Nicole C. Vissichelli*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia Department of Infectious Diseases, Hunter Holmes McGuire Veteran’s Affairs Medical Center, Richmond, Virginia
Christine M. Orndahl
Affiliation:
Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
Jane A. Cecil
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia Department of Infectious Diseases, Hunter Holmes McGuire Veteran’s Affairs Medical Center, Richmond, Virginia
Emily M. Hill
Affiliation:
Department of Pathology, Hunter Holmes McGuire Veteran’s Affairs Medical Center, Richmond, Virginia
Matthew M. Hitchcock
Affiliation:
Department of Infectious Diseases, Hunter Holmes McGuire Veteran’s Affairs Medical Center, Richmond, Virginia
Roy T. Sabo
Affiliation:
Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
Michael P. Stevens
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
Dan Tassone
Affiliation:
Department of Infectious Diseases, Hunter Holmes McGuire Veteran’s Affairs Medical Center, Richmond, Virginia
Leroy B. Vaughan
Affiliation:
Department of Infectious Diseases, Hunter Holmes McGuire Veteran’s Affairs Medical Center, Richmond, Virginia
J. Daniel Markley
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia Department of Infectious Diseases, Hunter Holmes McGuire Veteran’s Affairs Medical Center, Richmond, Virginia
*
Author for correspondence: Nicole Vissichelli, E-mail: Nicole.Vissichelli@vcuhealth.org

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.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.

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Footnotes

PREVIOUS PRESENTATION. These data were accepted as an abstract poster presentation for ID Week 2020 on October 21–25, 2020, at this virtual conference online.

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