title: Early optimization of antimicrobial therapy improves clinical outcomes of patients administered agents targeting methicillin-resistant Staphylococcus aureus.
abstract: OBJECTIVE
  Antimicrobial stewardship is required to ensure the appropriate use of antimicrobials. However, no reports have been published on clinical outcomes of implementation of antimicrobial stewardship in patients receiving pathogen-specific antibiotics.
  
  
  METHODS
  To evaluate the clinical outcomes of patients who received drugs, we conducted a single-centre, retrospective study of the effects of an antimicrobial stewardship programme targeting methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  RESULTS
  The time to administer effective antimicrobials was significantly (median number of days, 3 before vs. 0 after, P < 0·001) shortened, and the rate of de-escalation was significantly elevated (47·1% vs. 96·2%, P < 0·001) after implementation of daily review. The 60-day clinical failure associated with Gram-positive bacterial infection was significantly reduced (33·3% vs. 17·6%, P = 0·007) after intervention.
  
  
  CONCLUSIONS
  Daily review of administration of antimicrobials targeting MRSA was highly effective in improving clinical outcomes by optimizing early antimicrobial therapy.
authors.affiliation: Department of Pharmacy, Gifu University Hospital, Gifu, Japan.|Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Niwa
authors.affiliation: Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ohta
authors.affiliation: Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Nakayama
authors.affiliation: Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Tsuchiya
authors.affiliation: Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yasuda
authors.affiliation: Center for Nutrition Support & Infection Control, Gifu University Hospital, Gifu, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Murakami
authors.affiliation: Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Itoh
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D017723:Drug Utilization Review; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: MRSA; adverse event; antimicrobial stewardship; clinical failure; daily review; de-escalation