Vol.74 No.5 September 2026

Impact of daily antimicrobial stewardship team activities in a hospital without infectious disease physicians or dedicated AST pharmacists: A retrospective study of blood culture–positive patients

Shinji Sawada^{1, 2)}, Masaki Fujita^{1, 2)}, Sho Kishimoto¹⁾, Yohei Mitsutaka¹⁾, Koki Yoshimura¹⁾, Sho Oyama¹⁾, Takahiro Hyuga²⁾, Atsuhiro Morita^{2, 3)} and Kanji Tomogane¹⁾

¹⁾Department of Pharmacy, Kyoto Daini Red Cross Hospital, 355-5 Haruobi, Marutamachi-agaru, Kamanza-dori, Kamigyo-ku, Kyoto, Kyoto, Japan
²⁾Infection Control Office, Kyoto Daini Red Cross Hospital
³⁾Department of Gastroenterology, Kyoto Daini Red Cross Hospital

Abstract

Interventions by antimicrobial stewardship teams (ASTs) have been shown to improve the quality of antimicrobial therapy; however, the impact of the frequency of AST activities on the clinical outcomes has not yet been fully evaluated. In this study, we retrospectively investigated the effect of daily AST activities on the clinical outcomes in a hospital without infectious disease physicians or dedicated AST pharmacists.
A total of 5,714 patients with positive blood cultures at our hospital between 2012 and 2024 were included. The patients were categorized into two groups according to the AST activity schedule: Weekly AS group and Daily AS group. Propensity score matching was performed using age, sex, underlying diseases, and the Pitt Bacteremia Score, which yielded 913 matched patients in each group. As compared with the Weekly AS group, the Daily AS group showed significantly higher rates of AST intervention (41.1% vs. 18.9%, p<0.01), appropriate antimicrobial therapy (93.4% vs. 83.0%, p<0.01), de-escalation (37.2% vs. 18.8%, p<0.01), and switch to oral antimicrobial therapy (35.6% vs. 18.3%, p<0.01). Furthermore, the time from blood culture positivity to initiation of appropriate antimicrobial therapy was significantly shorter in the Daily AS group (median 0 vs. 1 day, p<0.01). In addition, the median length of hospital stay was significantly shorter (19 vs. 30 days, p<0.01) and the 30-day mortality was significantly lower (4.1% vs. 10.8%, p<0.01) in the Daily AS group. These findings suggest that even in hospitals without infectious disease physicians or dedicated AST pharmacists, daily AST activities enable timely intervention and could improve clinical outcomes, including shorter hospital stays and reduced mortality, through enhanced optimization of antimicrobial therapy.

Key word

antimicrobial stewardship, bacteremia, clinical outcome, mortality, length of stay

Received

March 19, 2026

Accepted

May 19, 2026

Jpn. J. Chemother. 74 (5): 547-555, 2026