Impact of discontinuing antibiotic susceptibility testing for Enterococcus faecalis-positive urine cultures on...

This single-center, observational, retrospective, before-after comparative study conducted in a tertiary care public hospital assessed the impact of discontinuing routine antibiotic susceptibility testing for Enterococcus faecalis in urine cultures on antibiotic prescribing patterns. Secondary objectives were to evaluate prescriber acceptability and the impact of the intervention by patient sex and on targeted antibiotic therapies.

A total of 229 consecutive monomicrobial E. faecalis-positive urine cultures from hospitalized adults were included. Two study periods were compared according to the intervention's implementation. In the pre-intervention period (December 2018-December 2019), antibiotic susceptibility testing was performed and fully reported, while in the post-intervention period (December 2019-December 2020), this was replaced by the following standardized sentence: "Species (usually) sensitive to amoxicillin; selective reporting of antibiotic susceptibility testing may be carried out upon request if there is a contraindication to the use of amoxicillin."

Overall, 120 urine cultures were analyzed during the pre-intervention period and 109 during the post-intervention period. Penicillin prescriptions increased in the overall cohort (28/67 vs 36/55; p = 0.011) and among male patients (21/54 vs 24/33; p = 0.004). Non-significant decreases were observed in overall fluoroquinolone use (12/67 vs 3/55; p = 0.051) and targeted antibiotic therapies (9/39 vs 3/43, p = 0.059). Acceptability rate was high (97%).

Discontinuation of routine antibiotic susceptibility testing reporting for E. faecalis-positive urine cultures was associated with a shift in antibiotic prescribing patterns, with increased penicillin use and a possible reduction in fluoroquinolone prescriptions.