Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Apr 17, 2023)
Date Submitted: Jul 27, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Comments by microbiologists for interpreting antimicrobial susceptibility testing and improving the appropriateness of antibiotic therapy in community-acquired urinary tract infections: a randomized, double-blind, digital, case-vignette, controlled, superiority trial.
ABSTRACT
Background:
Urinary tract infections account for most antibiotic prescriptions in primary care, with the use of broad-spectrum antibiotics and a high level of inappropriateness. Microbiologists are involved in antimicrobial stewardship programs and could help improve antibiotic prescribing through antimicrobial susceptibility reporting.
Objective:
To assess the added value of antimicrobial susceptibility testing (AST) comments issued by microbiologists on the quality of antibiotic prescriptions in community-acquired urinary tract infections (UTI).
Methods:
We conducted a superiority, double-blind, digital, randomized case-vignette study among French general practitioners (GP’s) between 11-24-2020 and 06-24-2021. Self-questionnaires containing one of the 6 case-vignette with or without comment were broadcasted via French general medical councils and regional residents’ unions. The primary outcome was the overall appropriateness of the antibiotic therapy prescribed according to last 2018 French guidelines for the management of community-acquired UTI.
Results:
Among 815 GP’s who responded to the questionnaire, 64,7% were women, with an average age of 37 years. Most of the GP’s (90,1%) used a Clinical Decision Support System. Empirical antibiotic therapy was appropriate in 71.9% (95CI, 68.8–75.0) of the cases, without differences between arms. The overall level of appropriateness for targeted antibiotic therapy did not differ with (83.4%) or without a comment (79.9%) (OR=1.26 (95CI, 0.86–1.85)). The appropriateness was the highest in asymptomatic bacteriuria in pregnant women (99.0%), and the lowest in indwelling urinary catheter-associated bacteriuria (52.9%). In multivariate analysis, only a hospital practice improved the appropriateness of the prescription by 2-folds (OR=2.38 (95CI, 1.02–6.16)).
Conclusions:
In a young GPs’ population comments for antimicrobial susceptibility testing in UTI did not improve the appropriateness of targeted antibiotic prescription.
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