Effect of directive laboratory comments on prescribing response to positive throat swab cultures.

Autor:	Bloomfield M; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand.; Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand.; Antimicrobial Stewardship Committee, Te Whatu Ora-Capital, Coast and Hutt Valley, Wellington, New Zealand., van der Werff K; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand., Todd S; Antimicrobial Stewardship Committee, Te Whatu Ora-Capital, Coast and Hutt Valley, Wellington, New Zealand.; Ora Toa Cannons Creek General Practice, Porirua, New Zealand., Balm M; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand.; Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand.; Antimicrobial Stewardship Committee, Te Whatu Ora-Capital, Coast and Hutt Valley, Wellington, New Zealand., Blackmore T; Department of Microbiology, Wellington Southern Community Laboratories, Wellington, New Zealand.; Department of Infection Services, Wellington Regional Hospital, Wellington, New Zealand.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2024 Feb 01; Vol. 79 (2), pp. 334-338.
DOI:	10.1093/jac/dkad384
Abstrakt:	Background: In patients without ethnicity risk factors for acute rheumatic fever (ARF), our local guidelines recommend limiting antibiotic use following a positive throat swab culture (TSC). If symptoms are severe, a 5-7 day course is recommended. Despite this, most local patients with a positive TSC for group A Streptococcus (GAS) or Streptococcus dysgalactiae subsp. equisimilis (SDSE) were being prescribed 10 days of antibiotics. In response, we added comments to positive TSC reports recommending shorter treatment durations in those without ARF risk factors. No other antimicrobial stewardship initiatives were implemented. Objectives: To assess the effect of these comments on antibiotic course duration after positive TSC. Methods: All community TSC results from 1 October 2021 to 31 March 2023 (1 year pre- to 6 months post-change) were matched to antibiotic dispensing data. Patients who had been empirically dispensed an antibiotic prior to the culture report were excluded. The outcome of interest was the antibiotic duration dispensed in the 5 day period after the TSC report. Results: Following introduction of the comments, median course duration reduced from 10 (IQR 5-10) to 7 days (IQR 0-10; P < 0.01) and from 7 (IQR 0-10) to 0 days (IQR 0-5; P < 0.01) following GAS- and SDSE-positive TSC, respectively, in those without ARF risk factors. The percentage of people receiving 10 days of antibiotics decreased from 63.0% to 37.0% (P < 0.01) and 41.2% to 14.6% (P < 0.01) for GAS and SDSE, respectively. Conclusions: The introduction of comments providing direct prescribing advice to requestors appears to have been highly effective at improving guideline-compliant prescribing following positive TSC report. (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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