Original articleEffect of interventions by an antimicrobial stewardship team on clinical course and economic outcome in patients with bloodstream infection
Introduction
In in-patient hospital settings, bloodstream infections (BSIs) are the most clinically important and serious condition [1]. BSIs are associated with high mortality and morbidity [2], [3], [4]. Successful strategies for BSI management have demonstrated substantial utility in improving patient prognosis and healthcare economics. Infectious disease specialists optimize infectious disease treatment by recommending appropriate diagnosis and antibiotic therapy [5]. In Japan, few hospitals have dedicated infectious disease departments and specialists, with few studies assessing the effect of specialist intervention on BSI clinical course [6].
We organized an interdisciplinary antimicrobial stewardship team (AST) [7] at our hospital comprising an infectious disease physician (IDP), a pharmacist, and a microbiological technologist who focused on patients with bacteremia since 2013 [8]. The clinical and economic benefits attributed to intervene of AST in patients with bacteremia have not been sufficiently studied. We aimed to provide additional clinical and economic data regarding our previous study [8] and evaluate its impact on the diagnosis, treatment, and clinical and economic outcomes.
Section snippets
Study design, setting, and sample
This single-center, retrospective, quasi-experimental study was performed at the Showa University Hospital, a 1014-bed teaching hospital in Tokyo, Japan. All hospitalized BSI patients during pre- (January 1–December 31, 2012) and post-intervention (April 1, 2013–March 31, 2014) periods were included. The study included a 3-month preliminary intervention period from January 1 to March 31, 2013 that was excluded from analysis. Exclusion criteria were duplication of records; discharge from
Clinical and microbiological characteristics
A total of 632 cases fulfilled the study criteria (pre-intervention, n = 308; post-intervention, n = 324). Patient demographics and comorbidities were similar between groups; however, SIRS and respiratory tract infection rates were lower during post-intervention period (Table 1). No significant difference in isolated microbiologic pathogens was observed between the groups (Fig. 1; P > 0.05).
Recommendations and acceptance rate
During the intervention, 152 recommendations were made by AST for 122 patients (Fig. 2). AST provided 74
Discussion
These results indicate that weekly AST interventions can decrease inappropriate therapy and potentially improve clinical and economic outcomes in BSI patients.
Previous studies have reported clinical intervention by infectious disease specialists reduces mortality, LOS [5], [15], [16], and medical costs [5]. Conversely, conflicting results have been reported regarding interventions for antimicrobial prescribing. Some studies [17], [18] have failed to determine a relationship between specialty
Conflict of interest
Takuma T, Shoji H, and Niki Y are endowed chairs and funded by Shionogi & Co., Ltd., Meiji Seika Pharma Co., Ltd. and Toyama Chemical Co., Ltd. Takuma T, Shoji H, and Niki Y received donations for this research from Takeda Pharmaceutical Co., Ltd., Pfizer Japan Inc., Daiichi Sankyo Co., Ltd., Bayer Yakuhin, Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Kyorin Pharmaceutical Co., Ltd., Astellas Pharma Inc., Chugai
Acknowledgments
None.
References (21)
- et al.
Clinical effect of a multidisciplinary team approach to the initial treatment of patients with hospital-acquired bloodstream infections at a Japanese university hospital
Am J Infect Control
(2014) A multicenter analysis of epidemiology of the nosocomial bloodstream infections in Japanese university hospitals
Clin Microbiol Infect
(2013)- et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS
Chest
(2007) - et al.
The influence of inadequate empirical antimicrobial treatment on patients with bloodstream infections in an intensive care unit
Clin Microbiol Infect
(2003) - et al.
Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study
Clin Infect Dis
(2004) - et al.
Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia
Clin Infect Dis
(2003) - et al.
Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome
Antimicrob Agents Chemother
(2005) - et al.
Impact of inadequate empirical therapy on the mortality of patients with bloodstream infections: a propensity score-based analysis
Antimicrob Agents Chemother
(2012) - et al.
Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs
Clin Infect Dis
(2014)
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Blood culture reports by infectious disease physicians can improve prognosis of bacteremia, including weekend-onset cases
2020, International Journal of Infectious DiseasesCitation Excerpt :Patients were excluded from this study if they met any of the following criteria: isolation of skin microflora, including coagulase-negative Staphylococci, Bacillus spp. Corynebacterium spp. and Propionibacterium spp. (Maeda et al. 2016; Nagao 2013; Weinstein et al. 1997). Both ICU and general ward cases were included in this study.
Direct antibiotic susceptibility testing of blood cultures of gram-negative bacilli using the Drug Susceptibility Testing Microfluidic (DSTM) device
2020, Journal of Infection and ChemotherapyCitation Excerpt :In addition, the rates of ESBL-producing bacteria isolated from bacteremic patients is increasing annually [17,18]. It has further been shown that rapid and appropriate antibiotic treatment leads to decreased rates of ESBL-producing microorganisms and lower mortality rates due to sepsis [19–24], indicating that quick drug susceptibility and resistance testing of culture-positive blood samples is vital in the treatment of bloodstream infections. Using the DSTM method, it is possible to directly test for drug susceptibilities in these samples, yielding drug susceptibility information approximately 3 h after confirmation of infection.
Proactive infectious disease consultation at the time of blood culture collection is associated with decreased mortality in patients with methicillin-resistant Staphylococcus aureus bacteremia: A retrospective cohort study
2020, Journal of Infection and ChemotherapyCitation Excerpt :Another study showed that the early bedside intervention of ID specialists in the Emergency Department was effective in reducing 14-day mortality of patients with severe sepsis and septic shock, by improving the approach to microbiological work-up, prompt administration of appropriate antimicrobial therapy, and compliance with all items in the Surviving Sepsis Campaign bundle [20]. However, in most existing studies regarding the impact of ID specialty care on bloodstream infections, ID consultations were started upon request or mandatory after notification of positive blood cultures [1,10,21–23]. In addition, to our knowledge, no previous studies have focused on the role of early ID consultation input for MRSAB in the current era of decreasing methicillin resistance rates (approaching 30%), and the implementation of antimicrobial stewardship programs has recently been encouraged.
The intervention by an antimicrobial stewardship team can improve clinical and microbiological outcomes of resistant gram-negative bacteria
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Management: from antibiotic stewardship to clinical microbiology
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