Vol.65 No.5 September 2017
Evaluation of daily review by an infectious diseases physician combined with antimicrobial stewardship team interventions on clinical outcomes in patients with bloodstream infections, using a quasi-experimental design
1)Division of Infection Control Sciences, Department of Clinical Pharmacy, 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 Microbiological Laboratory, Showa University Hospital
5)Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
Abstract
The antimicrobial stewardship team (AST) plays an important role in assisting with the treatment of infectious diseases. We organized an AST at our hospital comprising infectious disease specialists who focused on patients with bloodstream infections (BSIs). Our previous study reported that weekly AST interventions could decrease inappropriate therapy in BSI patients. Our aim was to determine whether a daily review by an infectious diseases physician (IDP) combined with weekly AST intervention would improve the clinical outcomes for patients with BSIs.
We conducted a retrospective, pre-post quasi-experimental study of BSI patients at a single Japanese university hospital. Hospitalized BSI patients during weekly- (April, 2013 - March, 2014) and daily-intervention (April, 2015 - March, 2016) period were included. All positive blood culture results were reviewed daily by IDP and reviewed weekly by the AST. The AST including IDP provided recommendations to attending physicians regarding appropriate diagnosis, therapy, and management of BSI patients. Propensity score matching was used to estimate the effects of patients demographics, comorbidities, severity indices, and infection site on mortality and length of stay (LOS).
During the weekly- and daily-interventions, 109 and 190 recommendations were made by the AST, respectively. Based on the propensity score, 252 patients in the weekly-intervention group were matched with 252 patients in the daily-intervention group. Comparing the 2 groups matched by the propensity score, the odds ratio for daily-intervention was 0.57 for in-hospital mortality (95% confidence interval, 0.36-0.90; P = 0.016). No significant difference in median LOS was observed between the matched groups (28 days vs. 22 days; P=0.053).
Daily review by an IDP combined with weekly AST intervention reduced mortality in BSI patients compared with only weekly AST intervention. Our study demonstrates that rapid intervention by infectious disease specialists decreased time to effective and optimal therapy, which was associated with a decrease in mortality.
Key word
antimicrobial stewardship, bloodstream infection, mortality, rapid intervention
Received
February 3, 2017
Accepted
March 10, 2017
Jpn. J. Chemother. 65 (5): 751-757, 2017
