title: Restrictive reporting of selected antimicrobial susceptibilities influences clinical prescribing.
abstract: BACKGROUND
  Cascade and restrictive reporting are useful strategies to enhance antibiotic stewardship programs.
  
  
  METHODS
  We combined both strategies to improve the prescribing of antibiotics aimed at Gram-negative infections.
  
  
  RESULTS
  For Enterobacter aerogenes, the susceptibility rates to amikacin increased from 10% to 100%; for third generation cephalosporins, these rates increased from 55% to 89%. The susceptibility rates of E. aerogenes to cefepime and piperacillin-tazobactam changed little, and the ampicillin susceptibility decreased from 30% in 2009 to 11% in 2010. For Proteus mirabilis, the susceptibility rates increased for third-generation cephalosporins (48% vs. 92%) and piperacillin-tazobactam (10% vs. 98%), with minimal changes for cefepime (96% vs. 93%), ampicillin (69% vs. 73%) and amikacin (96% vs. 84%). For Pseudomonas aeruginosa, the susceptibility rates improved slightly for third-generation cephalosporins (81% vs. 91%) but reduced for piperacillin-tazobactam (99% vs. 59%). Hospital-acquired Clostridium difficile infections decreased from 0.11 to 0.07 per 1000 patient days.
  
  
  CONCLUSIONS
  Selective reporting helps physicians choose the most appropriate antibiotics for their patients within a stewardship program, with reduced C. difficile infection.
authors.affiliation: Specialty Internal Medicine, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia; Indiana University School of Medicine, IN, USA. Electronic address: jaffar.tawfiq@aramco.com.
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.affiliation: Pharmacy Services Division, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia.
authors.forename: Hisham
authors.initials: H
authors.lastname: Momattin
authors.affiliation: Microbiology Lab, Saudi Aramco Medical Services Organization, Dhahran, Saudi Arabia.
authors.forename: Fatemah
authors.initials: F
authors.lastname: Al-Habboubi
authors.affiliation: Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Dancer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards*; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D012107:Research Design
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic stewardship; Antimicrobial resistance; DDD; Defined daily doses; Restrictive reporting