Vol.63 No.3 May 2015
Evaluation of interventions for bloodstream infections by an antimicrobial stewardship team in a Japanese university hospital
1)Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
2)Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University
3)Department of Pharmacy Services, Showa University Hospital
4)Department of Clinical Laboratory, Showa University Hospital
Abstract
No matter what the pathogen is, bacteremia is the most important and serious disease in community-acquired and nosocomial infections. The successful management of bacteremia is extremely helpful to improve a patient's prognosis and health care economics. Very little data have shown whether intervention of specialists has had an effect on the clinical course of bacteremia. We have organized an antimicrobial stewardship team(AST) in our hospital, consisting of an infectious disease physician, a pharmacist, a microbiological technologist and performed consultations focusing on the patients with bacteremia since 2013. The aim of our study was to evaluate the impact of interventions for cases of bacteremia on the diagnosis, treatment and patient outcome. One hundred sixty-five cases with bacteremia were included in the Intervention Group(IG) from April to September 2013. We defined 143 cases of bacteremia from January to June 2012 as the Control Group(CG). The cases in which contamination was suspected were excluded. We reviewed patient background (age, sex, body weight), severity index (sequential organ failure assessment(SOFA) score, systemic inflammatory response syndrome); underlying diseases (Charlson comorbidity index), and the source of infection. We evaluated the length of stay(LOS), mortality, inappropriate therapy (treatment of non-susceptible agents and persistent bacteria within 14 days).
We gave practical advice to 62 cases (37.6%) in IG whereas the other 103 cases (62.4%) were followed up without any advice. No significant difference was found in LOS and mortality between IG and CG. However, factors of treatment of non-susceptible agents and persistent bacteria tended to improve. In the multivariate analysis, no factor was found to have an effect on the LOS, whereas the risk factors related to mortality were the Charlson score, SOFA score and inappropriate therapy.
The multidisciplinary intervention in target patients with bacteremia by the AST reduced the inappropriate therapy. However, we were unable to prove that it might have an effect on patient prognosis. In Japan, many patients were admitted for various social factors (caring insurance, economic problem, family support, etc). Therefore the LOS wasn't reflected in the severity of the diseases. As a result, it may be difficult to evaluate the outcome using the LOS in Japan.
Key word
antimicrobial stewardship team, bacteremia, blood culture, sequential organ failure assessment score
Received
November 21, 2014
Accepted
January 16, 2015
Jpn. J. Chemother. 63 (3): 350-356, 2015
