Advertisement

Clinical outcomes of intervention for carbapenems and anti-methicillin-resistant Staphylococcus aureus antibiotics by an antimicrobial stewardship team

Published:August 17, 2021DOI:https://doi.org/10.1016/j.ajic.2021.08.011

      Highlights

      • Carbapenem and anti-MRSA antibiotic intervention showed 89.7% favorable outcome.
      • Carbapenem and anti-MRSA antibiotic intervention could reduce the antibiotic uses.
      • Discontinuation and de-escalation of antibiotics did not worsen clinical outcomes.

      Abstract

      Background

      There are no reports on the effects of interventions, such as discontinuation and change and/or de-escalation of carbapenems and anti-methicillin-resistant Staphylococcus aureus (MRSA) antibiotics by an antimicrobial stewardship team focusing on detailed patient outcomes. This study aimed to evaluate these effects.

      Methods

      This retrospective cohort study was conducted at a tertiary care hospital from December 2018 to November 2019.

      Results

      Favorable clinical responses were obtained in 165 of 184 cases (89.7%) in the intervention-accepted group, higher than those in the not accepted group (14/19 cases, 73.7%; P = .056). All-cause 30 day mortality was lower in the accepted group than in the not accepted group (1.1% and 10.5%, respectively; P = .045). The microbiological outcomes were similar between the two groups. Duration of carbapenem and anti-MRSA antibiotic use in the accepted group was significantly lower than that in the not accepted group (median [interquartile range]: 8 days [5-13] versus 14 days [8-15], respectively, P = .026 for carbapenem; 10 days [5.3-15] vs 15.5 days [13.8-45.3], respectively, P = .014 for anti-MRSA antibiotic).

      Conclusions

      This is the first study to investigate the effects of interventions such as discontinuation and change and/ or de-escalation of antibiotics on detailed outcomes. Our intervention could reduce the duration of carbapenem and anti-MRSA antibiotic use without worsening clinical and microbiological outcomes.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cao H
        • Phe K
        • Laine GA
        • Russo HR
        • Putney KS
        • Tam VH.
        An institutional review of antimicrobial stewardship interventions.
        J Glob Antimicrob Resist. 2016; 6: 75-77
        • Cosgrove SE
        The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs.
        Clin Infect Dis. 2006; 42: S82-S89
        • Roberts RR
        • Hota B
        • Ahmad I
        • et al.
        Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship.
        Clin Infect Dis. 2009; 49: 1175-1184
        • Dellit TH
        • Owens RC
        • McGowan Jr, JE
        • et al.
        Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.
        Clin Infect Dis. 2007; 44: 159-177
        • Barlam TF
        • Cosgrove SE
        • Abbo LM
        • et al.
        Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.
        Clin Infect Dis. 2016; 62: e51-e77
        • MacDougall C
        • Polk RE
        Antimicrobial stewardship programs in health care systems.
        Clin Microbiol Rev. 2005; 18: 638-656
        • Niwa T
        • Shinoda Y
        • Suzuki A
        • et al.
        Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital.
        Int J Clin Pract. 2012; 66: 999-1008
        • Fraser GL
        • Stogsdill P
        • Dickens Jr, JD
        • Wennberg DE
        • Smith Jr, RP
        • Prato BS
        Antibiotic optimization. An evaluation of patient safety and economic outcomes.
        Arch Intern Med. 1997; 157: 1689-1694
        • Cheng VC
        • To KK
        • Li IW
        • et al.
        Antimicrobial stewardship program directed at broad-spectrum intravenous antibiotics prescription in a tertiary hospital.
        Eur J Clin Microbiol Infect Dis. 2009; 28: 1447-1456
        • Cook PP
        • Gooch M
        Long-term effects of an antimicrobial stewardship programme at a tertiary-care teaching hospital.
        Int J Antimicrob Agents. 2015; 4: 262-267
        • Bantar C
        • Sartori B
        • Vesco E
        • et al.
        A hospital wide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance.
        Clin Infect Dis. 2003; 37: 180-186
        • DiazGranados CA
        Prospective audit for antimicrobial stewardship in intensive care: impact on resistance and clinical outcomes.
        Am J Infect Control. 2012; 40: 526-529
        • Lewis GJ
        • Fang X
        • Gooch M
        • Cook PP
        Decreased resistance of Pseudomonas aeruginosa with restriction of ciprofloxacin in a large teaching hospital's intensive care and intermediate care units.
        Infect Control Hosp Epidemiol. 2012; 33: 368-373
        • Philmon C
        • Smith T
        • Williamson S
        • Goodman E
        Controlling use of antimicrobials in a community teaching hospital.
        Infect Control Hosp Epidemiol. 2006; 27: 239-244
        • White Jr, AC
        • Atmar RL
        • Wilson J
        • Cate TR
        • Stager CE
        • Greenberg SB
        Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes.
        Clin Infect Dis. 1997; 25: 230-239
        • Liew YX
        • Lee W
        • Loh JC
        • et al.
        Impact of an antimicrobial stewardship programme on patient safety in Singapore General Hospital.
        Int J Antimicrob Agents. 2012; 40: 55-60
        • Horikoshi Y
        • Higuchi H
        • Suwa J
        • Isogai M
        • Shoji T
        • Ito K
        Impact of computerized pre-authorization of broad spectrum antibiotics in Pseudomonas aeruginosa at a children's hospital in Japan.
        J Infect Chemother. 2016; 22: 532-535
        • LaRocco Jr, A
        Concurrent antibiotic review programs—a role for infectious diseases specialists at small community hospitals.
        Clin Infect Dis. 2003; 37: 742-743
        • Goff DA
        • Bauer KA
        • Reed EE
        • Stevenson KB
        • Taylor JJ
        • West JE
        Is the “low-hanging fruit” worth picking for antimicrobial stewardship programs?.
        Clin Infect Dis. 2012; 55: 587-592
        • Vettese N
        • Hendershot J
        • Irvine M
        • Wimer S
        • Chamberlain D
        • Massoud N
        Outcomes associated with a thrice-weekly antimicrobial stewardship programme in a 253-bed community hospital.
        J Clin Pharm Ther. 2013; 38: 401-404
        • García-Rodríguez JF
        • Bardán-García B
        • Peña-Rodríguez MF
        • Álvarez-Díaz H
        • Mariño-Callejo A
        Meropenem antimicrobial stewardship program: clinical, economic, and antibiotic resistance impact.
        Eur J Clin Microbiol Infect Dis. 2019; 38: 161-170
        • Hagiwara D
        • Sato K
        • Miyazaki M
        • et al.
        The impact of earlier intervention by an antimicrobial stewardship team for specific antimicrobials in a single weekly intervention.
        Int J Infect Dis. 2018; 77: 34-39
        • Gilbert DN
        • Chambers HF
        • Eliopoulos GM
        • Saag MS
        • Pavia AT
        The Sanford Guide to Antimicrobial Therapy.
        48th ed. Antimicrobial Therapy, Vermont2018
        • Oda S
        • Aibiki M
        • Ikeda T
        • et al.
        The Japanese guidelines for the management of sepsis.
        J Intensive Care. 2014; 2: 55
        • Niwa T
        • Shinoda Y
        • Suzuki A
        • et al.
        Outcome measurement of the review system for appropriate use of antimicrobial injections in all inpatients established by the infection control team.
        Iryo Yakugaku. 2012; 38: 273-281
        • Shime N
        • Satake S
        • Fujita N
        De-escalation of antimicrobials in the treatment of bacteraemia due to antibiotic-sensitive pathogens in immunocompetent patients.
        Infection. 2011; 39: 319-325