Original article
Effect of interventions by an antimicrobial stewardship team on clinical course and economic outcome in patients with bloodstream infection

https://doi.org/10.1016/j.jiac.2015.11.004Get rights and content

Abstract

Background

Bloodstream infections (BSIs) represent one of the most severe and clinically important conditions in the hospital setting. We have organized an interdisciplinary antimicrobial stewardship team (AST) at our hospital and performed consultations focusing on BSI patients since 2013. This study aimed to evaluate the impact of AST interventions on the diagnosis, treatment, and clinical outcomes of BSI patients.

Methods

We conducted a retrospective quasi-experimental study of BSI patients at a single Japanese university hospital. AST provided recommendations to attending physicians regarding appropriate diagnosis, therapy, and management of BSI patients after reviewing medical charts.

Results

We identified a total of 308 cases of BSI from January to December, 2012 (pre-intervention group) and 324 cases of BSI from April, 2013 to March, 2014 (post-intervention group). No significant differences in the in-hospital mortality or 30-day mortality rates were observed between both the groups. Inappropriate therapy was initiated in a significantly lower proportion of patients in the post-intervention group (18.5% vs. 11.4%; P = 0.012). Multivariate analysis confirmed that inappropriate therapy was significantly associated with in-hospital mortality (odds ratio, 2.62; 95% confidence interval, 1.42–4.82; P = 0.002).

Conclusions

An interdisciplinary AST intervention approach decreases the use of inappropriate therapy and may improve clinical outcomes in BSI patients.

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)

There are more references available in the full text version of this article.

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