Point-Counterpoint: Cascade reporting-useful tool to support antimicrobial stewardship, or dangerously misleading.

Area of Science:

• Clinical Microbiology
• Infectious Diseases
• Antimicrobial Stewardship

Background:

• Antimicrobial resistance (AMR) necessitates multi-disciplinary strategies, including clinical laboratory involvement.
• Cascade reporting of antimicrobial susceptibility testing (AST) aims to promote narrow-spectrum antimicrobial use.
• Concerns exist regarding implementation complexity, long-term prescribing impact, compliance, and public health surveillance.

Purpose of the Study:

• To evaluate the benefits and risks of implementing AST cascade reporting.
• To explore expert opinions on the effectiveness and challenges of cascade reporting.

Main Methods:

• Review of existing literature and expert consensus on AST cascade reporting.
• Analysis of potential impacts on antimicrobial prescribing and resistance patterns.

Main Results:

• Cascade reporting can reduce the use of broad-spectrum antimicrobials and lower resistance rates.
• Implementation challenges include complexity, potential impact on prescribing behavior, and surveillance concerns.
• Expert consensus supports cascade reporting as a tool for antimicrobial stewardship.

Conclusions:

• AST cascade reporting offers benefits for antimicrobial stewardship.
• Careful protocol design and implementation are crucial to mitigate risks to patients and public health surveillance.
• Optimizing cascade reporting requires balancing antimicrobial stewardship goals with potential implementation hurdles.