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Nudging In MicroBiology Laboratory Evaluation (NIMBLE): A scoping review

Published online by Cambridge University Press:  04 November 2019

Bradley J. Langford Open the ORCID record for Bradley J. Langford [Opens in a new window] ,
Elizabeth Leung ,
Reem Haj ,
Mark McIntyre ,
Linda R. Taggart ,
Kevin A. Brown ,
Mark Downing  and
Larissa M. Matukas
Bradley J. Langford*
Affiliation:
Unity Health Toronto, Toronto, Ontario, Canada Public Health Ontario, Toronto, Ontario, Canada
Elizabeth Leung
Affiliation:
Unity Health Toronto, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Reem Haj
Affiliation:
Unity Health Toronto, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Mark McIntyre
Affiliation:
Sinai Health System, Toronto, Ontario, Canada
Linda R. Taggart
Affiliation:
Unity Health Toronto, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Kevin A. Brown
Affiliation:
Public Health Ontario, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Mark Downing
Affiliation:
Unity Health Toronto, Toronto, Ontario, Canada
Larissa M. Matukas
Affiliation:
Unity Health Toronto, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Bradley J. Langford, Email: brad.langford@gmail.com
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Abstract

Background:

Nudging in microbiology is an antimicrobial stewardship strategy to influence decision making through the strategic reporting of microbiology results while preserving prescriber autonomy. The purpose of this scoping review was to identify the evidence that demonstrates the effectiveness of nudging strategies in susceptibility result reporting to improve antimicrobial use.

Methods:

A search for studies in Ovid MEDLINE, Embase, PsycINFO, and All EBM Reviews was conducted. All simulated and vignette studies were excluded. Two independent reviewers were used throughout screening and data extraction.

Results:

Of a total of 1,346 citations screened, 15 relevant studies were identified. Study types included pre- and postintervention (n = 10), retrospective cohort (n = 4), and a randomized controlled trial (n = 1). Most studies were performed in acute-care settings (n = 13), and the remainder were in primary care (n = 2). Most studies used a strategy to alter the default antibiotic choices on the antibiotic report. All studies reported at least 1 outcome of antimicrobial use: utilization (n = 9), appropriateness (n = 7), de-escalation (n = 2), and cost (n = 1). Moreover, 12 studies reported an overall benefit in antimicrobial use outcomes associated with nudging, and 4 studies evaluated the association of nudging strategy with subsequent antimicrobial resistance, with 2 studies noting overall improvement.

Conclusions:

The number of heterogeneous studies evaluating the impact of applying nudging strategies to susceptibility result reports is small; however, most strategies do show promise in altering prescriber’s antibiotic selection. Selective and cascade reporting of targeted agents in a hospital setting represent the majority of current research. Gaps and opportunities for future research identified from our scoping review include performing prospective randomized controlled trials and evaluating other approaches aside from selective reporting.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 12 , December 2019 , pp. 1400 - 1406
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION. This work was presented in abstract form at the Association of Medical Microbiology and Infectious Diseases Canada (AMMI-Canada) and Canadian Association of Clinical Microbiology and Infectious Diseases (CACMID) Annual Conference on April 4, 2019, in Ottawa, Canada, and at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) on April 15, 2019, in Amsterdam, The Netherlands.

References

Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.CrossRefGoogle Scholar
Clinical and Laboratory Standards Institute. M100-ED29 Performance Standards for Antimicrobial Susceptibility Testing, 29th ed. Wayne, PA: CLSI; 2019.Google Scholar
Katchanov, J, Kluge, S, MacKenzie, CR, Kaasch, AJ. “Nudging” in microbiological reports: a strategy to improve prescribing. Infection 2017;45:123–127.CrossRefGoogle ScholarPubMed
Tricco, AC, Lillie, E, Zarin, W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169:467–473.CrossRefGoogle ScholarPubMed
Arksey, H, O’Malley, L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol 2005;8:19–32.CrossRefGoogle Scholar
Al-Tawfiq, JA, Momattin, H, Al-Habboubi, F, Dancer, SJ. Restrictive reporting of selected antimicrobial susceptibilities influences clinical prescribing. J Infect Public Health 2015;8:234–241.CrossRefGoogle ScholarPubMed
Barnes, MP. Influence of laboratory reports on prescribing of antimicrobials for urinary tract infection. J Clin Pathol 1980;33:481–483.CrossRefGoogle ScholarPubMed
Cunney, R, Aziz, HA, Schubert, D, McNamara, E, Smyth, E. Interpretative reporting and selective antimicrobial susceptibility release in non-critical microbiology results. J Antimicrob Chemother 2000;45:705–708.CrossRefGoogle ScholarPubMed
Daley, P, Garcia, D, Inayatullah, R, Penney, C, Boyd, S. Modified reporting of positive urine cultures to reduce inappropriate treatment of asymptomatic bacteriuria among nonpregnant, noncatheterized inpatients: a randomized controlled trial. Infect Control Hosp Epidemiol 2018;39:814–819.CrossRefGoogle ScholarPubMed
Foo, G, Tan, SY, Loh, ZC, Chung, WT, Chew, KL, Bagdasarian, N. Audit of the impact of selective reporting of fluoroquinolone susceptibility on prescribing habits in a tertiary hospital. Paper presented at the International Symposium on Antimicrobial Agents and Resistance and the 3rd International Interscience Conference on Infection and Chemotherapy (ISAAR & ICIC); Busan, Korea, September 15, 2017.Google Scholar
Johnson, LS, Patel, D, King, EA, Maslow, JN. Impact of microbiology cascade reporting on antibiotic de-escalation in cefazolin-susceptible gram-negative bacteremia. Eur J Clin Microbiol Infect Dis 2016;35:1151–1157.CrossRefGoogle ScholarPubMed
Langford, BJ, Seah, J, Chan, A, Downing, M, Johnstone, J, Matukas, LM. Antimicrobial stewardship in the microbiology laboratory: impact of selective susceptibility reporting on ciprofloxacin utilization and susceptibility of gram-negative isolates to ciprofloxacin in a hospital setting. J Clin Microbiol 2016;54:2343–2347.CrossRefGoogle Scholar
Leis, JA, Rebick, GW, Daneman, N, et al. Reducing antimicrobial therapy for asymptomatic bacteriuria among noncatheterized inpatients: a proof-of-concept study. Clin Infect Dis 2014;58:980–983.CrossRefGoogle ScholarPubMed
Liao, S, Rhodes, J, Sopirala, M. Out of sight—out of mind: impact of cascade reporting on Escherichia spp and Klebsiella infections. Paper presented at IDWeek; New Orleans, LA, October 28, 2016.CrossRefGoogle Scholar
Mcbride, J, Schulz, L, Fox, B, Dipoto, J, Sippel, N, Osterby, K. Influence of a “no MRSA, no Pseudomonas” comment to a respiratory culture in antibiotic utilization during the treatment of lower respiratory tract infection. Paper presented at IDWeek; San Diego, CA, October 10, 2015.CrossRefGoogle Scholar
McNulty, CA, Lasseter, GM, Charlett, A, et al. Does laboratory antibiotic susceptibility reporting influence primary care prescribing in urinary tract infection and other infections? J Antimicrob Chemother 2011;66:1396–1404.CrossRefGoogle ScholarPubMed
Musgrove, MA, Kenney, RM, Kendall, RE, et al. Microbiology comment nudge improves pneumonia prescribing. Open Forum Infect Dis 2018;5:ofy162.CrossRefGoogle Scholar
Steffee, CH, Morrell, RM, Wasilauskas, BL. Clinical use of rifampicin during routine reporting of rifampicin susceptibilities: a lesson in selective reporting of antimicrobial susceptibility data. J Antimicrob Chemother 1997;40:595–598.CrossRefGoogle ScholarPubMed
Tan, TY, McNulty, C, Charlett, A, Nessa, N, Kelly, C, Beswick, T. Laboratory antibiotic susceptibility reporting and antibiotic prescribing in general practice. J Antimicrob Chemother 2003;51:379–384.CrossRefGoogle ScholarPubMed
Brodowy, BA, Guglielmo, BJ, York, MK, Herfindal, ET, Brooks, GF. Experience with selective reporting of susceptibility to antimicrobial agents. Am J Hosp Pharm 1989;46:1816–1818.Google ScholarPubMed
Peterson, LR. Squeezing the antibiotic balloon: the impact of antimicrobial classes on emerging resistance. Clin Microbiol Infect 2005;11 Suppl 5:S4–S16.CrossRefGoogle ScholarPubMed
Pulcini, C, Tebano, G, Mutters, NT, et al. Selective reporting of antibiotic susceptibility test results in European countries: an ESCMID cross-sectional survey. Int J Antimicrob Agents 2017;49:162–166.CrossRefGoogle ScholarPubMed
Bourdellon, L, Thilly, N, Fougnot, S, Pulcini, C, Henard, S. Impact of selective reporting of antibiotic susceptibility test results on the appropriateness of antibiotics chosen by French general practitioners in urinary tract infections: a randomised controlled case-vignette study. Int J Antimicrob Agents 2017;50:258–262.CrossRefGoogle ScholarPubMed
Coupat, C, Pradier, C, Degand, N, Hofliger, P, Pulcini, C. Selective reporting of antibiotic susceptibility data improves the appropriateness of intended antibiotic prescriptions in urinary tract infections: a case-vignette randomised study. Eur J Clin Microbiol Infect Dis 2013;32:627–636.CrossRefGoogle ScholarPubMed
Papanicolas, LE, Nelson, R, Warner, MS. Influence of antimicrobial susceptibility reporting on junior doctors’ decision to prescribe antimicrobials inappropriately. J Antimicrob Chemother 2017;72:1202–1205.Google ScholarPubMed
Michie, S, Richardson, M, Johnston, M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46:81–95.CrossRefGoogle ScholarPubMed
Michie, S, van Stralen, MM, West, R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 2011;6:42-5908-6-42.CrossRefGoogle Scholar
Morgan, DJ, Malani, P, Diekema, DJ. Diagnostic stewardship—leveraging the laboratory to improve antimicrobial use. JAMA 2017;318:607–608.CrossRefGoogle Scholar
Munigala, S, Rojek, R, Wood, H, et al. Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: analysis from a large academic medical center. Infect Control Hosp Epidemiol 2019;40:281–286.CrossRefGoogle ScholarPubMed
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