The impact of diagnostic microbiology on de-escalation of antimicrobial therapy in hospitalised adults

BMC Infectious Diseases

Table 1 Impact of diagnostic microbiology on antimicrobial prescribing for different prescription episode indications

Indication type	Total prescriptions analysed	Prescription episodes (PE)	PE with micro: all*	PE with relevant positive micro *	Positive micro result documented **	Positive micro with ID/micro team involved **	Positive micro where Abx were affected**	Positive micro where Abx were de-escalated**	PE with only negative micro*	Negative micro reviewed & relevant	Reviewed negative micro result documented***	Reviewed negative micro result affected Abx
Respiratory	134	90	56 (62%)	10 (11%)	7 (70%)	7 (70%)	5 (50%)	1 (10%)	45 (50%)	19	4 (21%)	0
Urinary	51	44	28 (64%)	8 (18%)	7 (88%)	4 (50%)	3 (38%)	2 (25%)	19 (43%)	4	1 (25%)	0
Sepsis unclear source	51	35	27 (77%)	4 (11%)	4 (100%)	4 (100%)	4 (100%)	2 (50%)	22 (63%)	4	1 (25%)	1
Skin and soft tissue	44	34	14 (41%)	1 (3%)	1 (100%)	1 (100%)	1 (100%)	0	13 (38%)	3	1 (33%)	0
Abdominal	27	18	11 (61%)	2 (11%)	2 (100%)	2 (100%)	2 (100%)	0	8 (44%)	3	1 (33%)	0
Other	34	22	11 (50%)	5 (23%)	5 (100%)	5 (100%)	5 (100%)	1 (20%)	5 (23%)	4	1 (25%)	0
No indication documented	41	33	15 (45%)	3 (9%)	1 (33%)	0	0	0	12 (36%)	3	0	0
TOTAL	382	276	162 (59%)	33 (12%)	27 (82%)	23 (70%)	20 (61%)	6 (18%)	124 (45%)	40	9 (23%)	1 (2.5%)

Table shows the total prescriptions sampled for different indications, the Prescription Episodes analysed (PEs, defined in main text), and various properties of PEs with positive and negative diagnostic microbiology found on detailed notes review. For PEs with positive microbiology, data were collected on whether the microbiology result was documented in the medical records, whether infectious diseases and/or microbiology teams were involved (either by telephone or patient review), whether the antimicrobial regimen was changed as a result of the microbiology and whether that change constituted escalation or de-escalation. For a random sample of PEs with negative microbiology, data were collected on whether the result was acknowledged in the medical records and whether this caused antimicrobial de-escalation. ID Infectious Diseases team. * = Denominator for percentages is all PEs for that indication; ** = Denominator for percentages is all PEs with pathogenic positive microbiology; *** = Denominator for percentages is reviewed PEs with negative microbiology

ISSN: 1471-2334