title: Automatic day-2 intervention by a multidisciplinary antimicrobial stewardship-team leads to multiple positive effects.
abstract: BACKGROUND
  Antimicrobial resistance rates are increasing. This is, among others, caused by incorrect or inappropriate use of antimicrobials. To target this, a multidisciplinary antimicrobial stewardship-team (A-Team) was implemented at the University Medical Center Groningen on a urology ward. Goal of this study is to evaluate the clinical effects of the case-audits done by this team, looking at length of stay (LOS) and antimicrobial use.
  
  
  METHODS
  Automatic e-mail alerts were sent after 48 h of consecutive antimicrobial use triggering the case-audits, consisting of an A-Team member visiting the ward, discussing the patient's therapy with the bed-side physician and together deciding on further treatment based on available diagnostics and guidelines. Clinical effects of the audits were evaluated through an Interrupted Time Series analysis and a retrospective historic cohort.
  
  
  RESULTS
  A significant systemic reduction of antimicrobial consumption for all patients on the ward, both with and without case-audits was observed. Furthermore, LOS for patients with case-audits who were admitted primarily due to infections decreased to 6.20 days (95% CI: 5.59-6.81) compared to the historic cohort (7.57 days; 95% CI: 6.92-8.21; p = 0.012). Antimicrobial consumption decreased for these patients from 8.17 DDD/patient (95% CI: 7.10-9.24) to 5.93 DDD/patient (95% CI: 5.02-6.83; p = 0.008). For patients with severe underlying diseases (e.g., cancer) these outcome measures remained unchanged.
  
  
  CONCLUSIONS
  The evaluation showed a considerable positive impact. Antibiotic use of the whole ward was reduced, transcending the intervened patients. Furthermore, LOS and mean antimicrobial consumption for a subgroup was reduced, thereby improving patient care and potentially lowering resistance rates.
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands.
authors.forename: Jan-Willem H
authors.initials: JW
authors.lastname: Dik
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands ; Certe Laboratory for Infectious Diseases Groningen, Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: Hendrix
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands.
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Lo-Ten-Foe
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands.
authors.forename: Kasper R
authors.initials: KR
authors.lastname: Wilting
authors.affiliation: Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen Groningen, Netherlands.
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Panday
authors.affiliation: Department of Psychology, Health and Technology, University of Twente Enschede, Netherlands.
authors.forename: Lisette E
authors.initials: LE
authors.lastname: van Gemert-Pijnen
authors.affiliation: Department of Urology, University Medical Center Groningen Groningen, Netherlands.
authors.forename: Annemarie M
authors.initials: AM
authors.lastname: Leliveld
authors.affiliation: Department of Research Methodology, Measurement and Data Analysis, University of Twente Enschede, Netherlands ; Department of Epidemiology, Medisch Spectrum Twente Enschede, Netherlands.
authors.forename: Job
authors.initials: J
authors.lastname: van der Palen
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands.
authors.forename: Alex W
authors.initials: AW
authors.lastname: Friedrich
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen Groningen, Netherlands.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Sinha
keywords: A-Teams; antimicrobial prescription; antimicrobial resistance; antimicrobial stewardship; intervention study