Let’s take the following scenario…
You isolate an E. coli from a blood culture, and it turns out to be susceptible to all the antibiotics that you have tested it against (everything from amoxycillin to meropenem).
So how many antibiotics do you (the lab) report to the clinicians for the above case?
i) One, amoxycillin (with a comment saying other susceptibilities available on request)
ii) Two or three relatively narrow spectrum agents.
iii) Several choices, including broad spectrum ones like ceftriaxone, piperacillin/tazobactam or meropenem.
iv) “The works”! i.e. everything you test against.
I suspect a good proportion of laboratories would fall into category iii !
But really I think we should all be in category i or ii…
Meropenem & co. should never get near a microbiology result report unless it is clear it is really needed.
Out of sight, out of mind…
Traditionally clinical microbiology laboratories would give as much information as possible to the clinicians (we are far too nice…), but with little regard to the potential collateral damage such a policy could cause.
Remember that clinicians may have different agendas when treating an individual patient. (Check this article out)
Things are changing. People are beginning to realise just how important a role the laboratory can play in good anti-microbial stewardship. As the discipline grows, this will become a core focus for microbiologists.
It is not just antibiotic reporting of course. The laboratory has many other important roles in the field of anti-microbial stewardship such as :
- Creating an “antibiogram” to guide empiric antibiotic choices for guidelines.
- Use of rapid diagnostics to expedite identification of causative organisms.
- Use of rapid diagnostics to expedite identification of MDROs.
- Use of suitable report comments to discourage antibiotic use when the result suggests it may not be necessary.
The microbiology result report is key in communicating the laboratory information to clinicians in such a manner that the result is interpreted the way we want it to be.
Stay narrow, stay focused…