Daily Review of Antimicrobial Use Facilitates the Early Optimization of Antimicrobial Therapy and Improves Clinical Outcomes of Patients with Bloodstream Infections

Abstract

Insufficient information is available to confirm the beneficial effects of implementing an antimicrobial stewardship program in reducing mortality of patients with bloodstream infections. A single institutional cohort study was conducted to evaluate clinical outcomes after implementation of a daily review of antimicrobials used to treat patients with bloodstream infections. Subjects were allocated to groups receiving either intervention or nonintervention. After implementation of an antimicrobial stewardship program, the day from the onset of infection required to administer effective intravenous antimicrobial treatment was significantly shortened (p 0.022), and the rate of de-escalation was significantly elevated (p<0.001) compared with the nonintervention group. Further, the rate of 30-d death associated with bloodstream infection was siginificantly reduced from 11.4 to 5.4% (p 0.030) compared with the nonintervention group. The incidence of adverse events was significantly lower in the intervention group than in the nonintervention group (7.7 vs. 28.0%, p<0.001). Our present findings suggest that daily review of the use of antimicrobials was highly effective for optimizing early antimicrobial therapy and improved clinical outcomes of patients with bloodstream infections. Key words daily review; antimicrobial use; adverse event; mortality; bloodstream infectionBacteremia is a serious clinical condition associated with high mortality. A multicenter retrospective cohort study conducted in the United States found that the median rate of bloodstream infection in hospital is 3.5 bloodstream infections per 1000 patient days, and the in-hospital mortality rate is 18%.1) The study further indicated that, for patients with bacteremia, timely and appropriate antimicrobial treatment is crucial.2) However, the inappropriate use of antibiotics in hospitals ranges from 26 to 57%.3-5) Therefore, implementation of antimicrobial stewardship is required to ensure appropriate use of antimicrobials.The guidelines of the Infectious Disease Society of America and the Society for Healthcare Epidemiology of America propose the core strategies for implementing antimicrobial stewardship designated "formulary restriction and pre-authorization" and "prospective audit with intervention and feedback." 6) Evidence indicates that the latter strategy is effective when implemented within 72 h of the initiation of antibiotic therapy. 7) In August 2009, we implemented a hospital-wide, multidisciplinary intervention program based on this strategy to optimize antibiotic use within 24 h after onset of therapy, which was unique in targeting all patients received intravenous antimicrobials, and found it highly effective in decreasing inappropriate use of antibiotics, reducing the length of hospitalization, reducing the rate of appearance of methicillin-resistant Staphylococcus aureus (MRSA), and reducing medical expenses. 8)Improved patient outcomes are an important benefit of implementing antimicrobial stewardship; however, limited data are availabl...

Clinical impact of matrix‐assisted laser desorption ionization‐time of flight mass spectrometry combined with antimicrobial stewardship interventions in patients with bloodstream infections in a Japanese tertiary hospital

“…Compared to conventional methods, implementation of MALDI‐TOF MS reduced the time to effective antimicrobial therapy and optimal antimicrobial therapy by an average of 13.3 and 38.4 hours, respectively. While our previous study showed that implementation of an antimicrobial stewardship reduced the time to effective antimicrobial therapy in patients with bloodstream infections, additional implementation of MALDI‐TOF MS reduced these times even further. Several studies have demonstrated that rapid identification of the causative organism from blood culture bottles using MALDI‐TOF MS combined with AST reduces the time to effective antimicrobial therapy ranging from 9.7 to 34.3 hours and the time to optimal antimicrobial therapy ranging from 12 to 43 hours compared with conventional culture methods, which is comparable with the present results.…”

“…The AST performed daily reviews of prescriptions for inpatients who received intravenous antimicrobials according to the prospective audit and feedback strategy. 17,18 This service was unchanged during both study periods. Briefly, we assembled a team comprising two physicians and three pharmacists who specialised in infectious diseases to implement the antimicrobial stewardship.…”

“…The AST performed daily reviews of prescriptions for inpatients who received intravenous antimicrobials according to the prospective audit and feedback strategy . This service was unchanged during both study periods.…”

“…We also reported that daily review of the use of antimicrobials improved the clinical outcomes of patients with bloodstream infections. 18 Furthermore, in April 2017, our clinical laboratory implemented the use of MALDI-TOF MS to identify the isolated organisms.…”

Brevinin-2 Drug Family—New Applied Peptide Candidates Against Methicillin-Resistant Staphylococcus aureus and Their Effects on Lys-7 Expression of Innate Immune Pathway DAF-2/DAF-16 in Caenorhabditis elegans

“…A series of strategies has been adopted to test new anti-infective agents in whole animal models such as Caenorhabditis elegans (C. elegans) [7]. Although the common screening method for new drugs using C. elegans is now widely recognized by researchers [8], the drug screening still focuses on the level of individual behavior (physiological indicators, mortality, etc.) in nematode infection models.…”