 |
Cascading the reporting of susceptibilities is a very tricky process and is frought with potential harm to the patient. One approach that labs are using is to cascade the reporting of cephalosporins but report any third or fourth generation cephalosporins that test I or R. We have often seen organisms with ESBLs that will test suceptibile to cefazolin but I or R to one of the 3rd generation cephalosporins. This can happen with any species within the Enterobacteriaceae and if you are not looking for and reporting ESBLs in all species of Enterobacteriaceae you may fail to report resistance to an antibiotic that the physician chooses to use. Same thing applies to cascading the reporting of aminoglycosides. We have seen a large number of Enterobacteriacea (mostly Proteus species) that test susceptible to gentamicin but resistant to tobramycin and amikacin. If you suppress the reporting of the resistant aminoglycosides because gentamicin is S and the physician decides to use tobra or amikacin because they deduce that if gent is S then all aminoglycosides are S, then potential harm may come to the patient. Decisions about cascading should be made with input from Pharmacy, Infectious Disease and microbiology. If you do decide to do cascade reporting then we suggest that you only suppress the reporting of higher generation susceptible drugs and report all resistant antibiotics irrespective of the cascading rules that you set up.
|
