Refining the reporting protocol of wound cultures reduced the use of antibiotics

Antimicrobial resistance, or the ability of bacteria to resist antibiotic treatment, is a global concern. Bacterial cultures are utilised in the selection of appropriate antibiotic treatment, but unnecessary tests, particularly antimicrobial susceptibility testing reports, may increase the use of antibiotics. 

In 2017 and 2018, HUS Diagnostic Center's Bacteriology laboratory refined its reporting protocol of susceptibility testing performed on bacterial wound culture samples.

"We reduced our reporting of susceptibility testing results for bacteria with low relevance for wound infections. In collaboration with the infectious disease specialists of HUS and the City of Helsinki, we studied the impact of the change in the reporting protocol on the use of antibiotics", says Jukka Torvikoski, specialist in clinical microbiology at HUS. 

The study compared the wound culture reports, antibiotic treatments, and treatment outcomes of patients in Laakso Hospital's wound-care ward from 2014 to 2016 (before the reporting protocol change) and from 2019 to 2021 (after the change). 

Use of antibiotics decreased after laboratory changed its reporting protocol

After the change in reporting protocols, significantly fewer susceptibility testing results were reported for bacteria with low relevance for wound infections. The change also reduced the escalation of antibiotic treatment in a more broad-spectrum direction that promotes antibiotic resistance. Furthermore, patients were less frequently treated with antibiotics. No differences were observed between the groups in other outcomes of treatment, such as length of hospital stay or all-cause mortality.

Use of antibiotics can be safely guided by refining reporting protocols

The results of the study suggest that microbiology laboratories could safely influence the antibiotic treatment decisions made by clinicians by limiting their reporting of susceptibility testing results for wound cultures. The findings emphasise the responsibility of microbiology laboratories in steering the use of antibiotics and combating the development of antimicrobial resistance.

The study was published in the peer-reviewed eBioMedicine journal, which is part of the Lancet Discovery Science publication series. 

Research article: Impact of selective reporting of wound cultures on microbiology reports and antimicrobial-drug use on a wound-care ward in Finland: a retrospective cohort study