title: Clinical effect of a multidisciplinary team approach to the initial treatment of patients with hospital-acquired bloodstream infections at a Japanese university hospital.
abstract: BACKGROUND
  Hospital-acquired bloodstream infections (BSIs) are significant causes of mortality, and strategies to improve outcomes are needed. We aimed to evaluate the clinical efficacy of a multidisciplinary infection control team (ICT) approach to the initial treatment of patients with hospital-acquired BSI.
  
  
  METHODS
  A before-after quasiexperimental study of patients with hospital-acquired BSI was performed in a Japanese university hospital. The ICT provided immediate recommendations to the attending physician about appropriate antimicrobial therapy and management after reviewing blood cultures, Gram's stain, final organism, and antimicrobial susceptibility results.
  
  
  RESULTS
  The sample included 469 patients with hospital-acquired BSI (n = 210, preintervention group; n = 259, postintervention group). There were no significant differences between the groups in background or microbiologic characteristics. The 30-day mortality was significantly lower and significantly more patients received appropriate antimicrobial therapy in the postintervention group (22.9% vs 14.3%; P = .02 and 86.5% vs 69.0%; P < .001, respectively). Multivariate analysis confirmed that the ICT intervention was significantly associated with appropriate antimicrobial therapy (odds ratio, 2.22; 95% confidence interval, 1.27-3.89) and 30-day mortality (odds ratio, 0.49; 95% confidence interval, 0.25-0.95).
  
  
  CONCLUSIONS
  A timely multidisciplinary team approach decreases the delay of appropriate antimicrobial treatment and may improve HABSI patient outcomes.
authors.affiliation: Department of Pharmacy, University of Fukui Hospital, Fukui, Japan; Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan. Electronic address: tsuka@u-fukui.ac.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Tsukamoto
authors.affiliation: Department of Pharmacy, University of Fukui Hospital, Fukui, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Higashi
authors.affiliation: Department of Pharmacy, University of Fukui Hospital, Fukui, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Pharmacy, University of Fukui Hospital, Fukui, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Yano
authors.affiliation: Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan; Clinical Laboratory, University of Fukui Hospital, Fukui, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Hida
authors.affiliation: Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Muroi
authors.affiliation: Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan; First Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ikegaya
authors.affiliation: Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Iwasaki
authors.affiliation: Department of Pharmacy, University of Fukui Hospital, Fukui, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Masada
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001419:Bacteria / Q000187:drug effects; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D010348:Patient Care Team
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appropriate antimicrobial therapy; Infection control team; Mortality