WHAT IS CASCADE LABORATORY REPORTING IN MICROBIOLOGY
Dr.T.V.Rao MD
Topic of Importance for Post graduate students in Microbiology Many Microbiology laboratories which practice with scientific spirit to reduce the antibiotic misuse and follow stewardship follow the Cascade system of reporting on bacteriological specimens sent for culture and sensitivity, Most of the times the Physicians wish to read the essence of the laboratory reports, they have little time to consider many matters we mean as Microbiologists The reporting of microbiology results can have a significant influence on antimicrobial selection; in this way, the microbiologist and microbiology laboratory can play an important role in antimicrobial stewardship, every patient with infection do not need a new generation of antibiotics, many follow Cascade reporting is recommended by laboratory standard groups; as such, at least some form of cascade reporting has been implemented by most microbiology laboratories ( in USA and European laboratories ). Cascading microbiology laboratory reporting, as defined by the Clinical and Laboratory Standards Institute, is a “strategy of reporting antimicrobial susceptibility test results in which secondary (e.g., broader-spectrum, more costly) agents may only be reported if an organism is resistant to primary agents within a particular drug class (cascade reporting is one type of selective reporting).”In this way, susceptibilities are performed for a panel of antimicrobial AGENTS but reported for only the narrowest-spectrum drugs while suppressing the susceptibilities of more broad-spectrum agents, higher-cost agents, high-toxicity agents or those with the potential for over prescription (secondary agents). The rationale behind cascade reporting is that if the secondary agents are not reported, it is less likely they will be prescribed
INCORPORATION INTO ANTIBIOTIC POLICY -Ideally, the institution’s microbiologist and microbiology laboratory should decide which agents to report routinely and which to report selectively. These decisions should be made in consultation with the institution’s antimicrobial management committee, subcommittee of pharmacy and therapeutics, and/or the antimicrobial stewardship team. Institutions with outsourced laboratory services should understand how their laboratory performs cascading and if necessary, inquire about customization. Today many Hospitals outsource the microbiology services so they have to informed what they truly need to practice policy so to restrict antibiotic misuse
HOW CLSI GUIDELINES HELP An example of a cascade reporting algorithm is as follows: “1) if an E. coli is susceptible to gentamicin, amikacin is not reported; 2) if an E. coli is susceptible to ceftriaxone, then meropenem is not reported
HOW ANTIBIOTIC STEWARD SHIP PROGRAMS IMPROVED WITH PRACTICE OF CASCADE SYSTEM OF REPORTING -Decisions about strategic reporting should be made collaboratively by the microbiologist and the antimicrobial stewardship team. It is important to ensure that any comments added to the reports are written clearly to reduce the chance of misinterpretation by the end user.
Many laboratories practice cascade system of reporting for many out patients and the patients being with trivial infection and not needing toxic and new generation of Antibiotics ,Many can be treated with minor group of narrow spectrum antibiotics References -1 Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement. Wayne, PA: CLSI; 2015. CLSI document M100-S25. 2 Antimicrobial Stewardship Strategy: Cascading microbiology susceptibility reportingFor further information Antimicrobial Stewardship Program, Infection Prevention and Control, Public Health Ontario.
Formulated by Dr.T.V.Rao MD for benefit of online university resources @ Antibiotic resistance
Dr.T.V.Rao MD
Topic of Importance for Post graduate students in Microbiology Many Microbiology laboratories which practice with scientific spirit to reduce the antibiotic misuse and follow stewardship follow the Cascade system of reporting on bacteriological specimens sent for culture and sensitivity, Most of the times the Physicians wish to read the essence of the laboratory reports, they have little time to consider many matters we mean as Microbiologists The reporting of microbiology results can have a significant influence on antimicrobial selection; in this way, the microbiologist and microbiology laboratory can play an important role in antimicrobial stewardship, every patient with infection do not need a new generation of antibiotics, many follow Cascade reporting is recommended by laboratory standard groups; as such, at least some form of cascade reporting has been implemented by most microbiology laboratories ( in USA and European laboratories ). Cascading microbiology laboratory reporting, as defined by the Clinical and Laboratory Standards Institute, is a “strategy of reporting antimicrobial susceptibility test results in which secondary (e.g., broader-spectrum, more costly) agents may only be reported if an organism is resistant to primary agents within a particular drug class (cascade reporting is one type of selective reporting).”In this way, susceptibilities are performed for a panel of antimicrobial AGENTS but reported for only the narrowest-spectrum drugs while suppressing the susceptibilities of more broad-spectrum agents, higher-cost agents, high-toxicity agents or those with the potential for over prescription (secondary agents). The rationale behind cascade reporting is that if the secondary agents are not reported, it is less likely they will be prescribed
INCORPORATION INTO ANTIBIOTIC POLICY -Ideally, the institution’s microbiologist and microbiology laboratory should decide which agents to report routinely and which to report selectively. These decisions should be made in consultation with the institution’s antimicrobial management committee, subcommittee of pharmacy and therapeutics, and/or the antimicrobial stewardship team. Institutions with outsourced laboratory services should understand how their laboratory performs cascading and if necessary, inquire about customization. Today many Hospitals outsource the microbiology services so they have to informed what they truly need to practice policy so to restrict antibiotic misuse
HOW CLSI GUIDELINES HELP An example of a cascade reporting algorithm is as follows: “1) if an E. coli is susceptible to gentamicin, amikacin is not reported; 2) if an E. coli is susceptible to ceftriaxone, then meropenem is not reported
HOW ANTIBIOTIC STEWARD SHIP PROGRAMS IMPROVED WITH PRACTICE OF CASCADE SYSTEM OF REPORTING -Decisions about strategic reporting should be made collaboratively by the microbiologist and the antimicrobial stewardship team. It is important to ensure that any comments added to the reports are written clearly to reduce the chance of misinterpretation by the end user.
Many laboratories practice cascade system of reporting for many out patients and the patients being with trivial infection and not needing toxic and new generation of Antibiotics ,Many can be treated with minor group of narrow spectrum antibiotics References -1 Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement. Wayne, PA: CLSI; 2015. CLSI document M100-S25. 2 Antimicrobial Stewardship Strategy: Cascading microbiology susceptibility reportingFor further information Antimicrobial Stewardship Program, Infection Prevention and Control, Public Health Ontario.
Formulated by Dr.T.V.Rao MD for benefit of online university resources @ Antibiotic resistance
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