title: Impact of microbiology cascade reporting on antibiotic de-escalation in cefazolin-susceptible Gram-negative bacteremia.
abstract: Cascade reporting (CR) involves reporting the susceptibilities of broad-spectrum agents only when the organism is resistant to more narrow-spectrum agents. The purpose of this study is to evaluate the impact of CR on antibiotic de-escalation practices and to characterize the impact of CR on clinical outcomes. CR rules were implemented in the microbiology laboratory at Atlantic Health System (AHS) in June 2013. A retrospective chart review was conducted at two community teaching hospitals in adult patients who had a blood culture positive for a Gram-negative organism susceptible to cefazolin and who were empirically treated with broad-spectrum beta-lactam (BSBL) antibiotics. De-escalation practices were compared in the pre-CR (July 2012-December 2012) and post-CR (July 2013-December 2013) periods. The primary endpoint was the percentage of patients whose BSBL agent was de-escalated to agents listed on the post-CR antibiotic susceptibility report within 48 h of the final report. Secondary endpoints include the difference in pre-CR and post-CR periods in terms of hospital length of stay, in-hospital mortality, 30-day readmission, Clostridium difficile infections, and re-initiation of a BSBL agent within 7 days. A total of 73 patients were included; 31 in the pre-CR and 42 in the post-CR period. Patients had similar baseline characteristics. Therapy was de-escalated in 48 % of pre-CR vs 71 % of post-CR patients (p = 0.043). No significant differences were observed in secondary endpoints between patients in the pre-CR and post-CR periods. CR resulted in significant improvements in de-escalation practices without affecting safety outcomes.
authors.affiliation: Department of Pharmacy, CHI Memorial, 2525 DeSales Avenue, Chattanooga, TN, 37404, USA. linda.johnson525@gmail.com.
authors.forename: L S
authors.initials: LS
authors.lastname: Johnson
authors.affiliation: Department of Pharmacy, Morristown Medical Center, 100 Madison Avenue, Morristown, NJ, 07960, USA.
authors.forename: D
authors.initials: D
authors.lastname: Patel
authors.affiliation: Department of Pharmacy, Overlook Medical Center, 99 Beauvoir Avenue, Summit, NJ, 07901, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: King
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Morristown Medical Center, 100 Madison Avenue, Morristown, NJ, 07960, USA.|GeneOne Life Science, Inc., 1040 DeKalb Pike, Suite 200, Blue Bell, PA, 19422, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Maslow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia; D002437:Cefazolin / Q000494:pharmacology* / Q000627:therapeutic use; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin