title: Effect of interventions by an antimicrobial stewardship team on clinical course and economic outcome in patients with bloodstream infection.
abstract: BACKGROUND
  Bloodstream infections (BSIs) represent one of the most severe and clinically important conditions in the hospital setting. We have organized an interdisciplinary antimicrobial stewardship team (AST) at our hospital and performed consultations focusing on BSI patients since 2013. This study aimed to evaluate the impact of AST interventions on the diagnosis, treatment, and clinical outcomes of BSI patients.
  
  
  METHODS
  We conducted a retrospective quasi-experimental study of BSI patients at a single Japanese university hospital. AST provided recommendations to attending physicians regarding appropriate diagnosis, therapy, and management of BSI patients after reviewing medical charts.
  
  
  RESULTS
  We identified a total of 308 cases of BSI from January to December, 2012 (pre-intervention group) and 324 cases of BSI from April, 2013 to March, 2014 (post-intervention group). No significant differences in the in-hospital mortality or 30-day mortality rates were observed between both the groups. Inappropriate therapy was initiated in a significantly lower proportion of patients in the post-intervention group (18.5% vs. 11.4%; P = 0.012). Multivariate analysis confirmed that inappropriate therapy was significantly associated with in-hospital mortality (odds ratio, 2.62; 95% confidence interval, 1.42-4.82; P = 0.002).
  
  
  CONCLUSIONS
  An interdisciplinary AST intervention approach decreases the use of inappropriate therapy and may improve clinical outcomes in BSI patients.
authors.affiliation: Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan. Electronic address: m-maeda@pharm.showa-u.ac.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Maeda
authors.affiliation: Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takuma
authors.affiliation: Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan; Department of Pharmacy Services, Showa University Hospital, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Seki
authors.affiliation: Department of Clinical Laboratory, Showa University Hospital, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Ugajin
authors.affiliation: Department of Pharmacy Services, Showa University Hospital, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Yuika
authors.initials: Y
authors.lastname: Naito
authors.affiliation: Department of Pharmacy Services, Showa University Hospital, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yoshikawa
authors.affiliation: Department of Pharmacy Services, Showa University Hospital, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Yamanaka
authors.affiliation: Department of Pharmacy Services, Showa University Hospital, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan; Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oto
authors.affiliation: Department of Pharmacy Services, Showa University Hospital, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan; Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: Minemura
authors.affiliation: Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shoji
authors.affiliation: Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Ishino
authors.affiliation: Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, 1-4-5 Hatanodai, Shinagawa-ku, Tokyo, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Niki
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D003141:Communicable Diseases / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship team; Appropriate therapy; Bloodstream infection