title: Daily Review of Antimicrobial Use Facilitates the Early Optimization of Antimicrobial Therapy and Improves Clinical Outcomes of Patients with Bloodstream Infections.
abstract: Insufficient information is available to confirm the beneficial effects of implementing an antimicrobial stewardship program in reducing mortality of patients with bloodstream infections. A single institutional cohort study was conducted to evaluate clinical outcomes after implementation of a daily review of antimicrobials used to treat patients with bloodstream infections. Subjects were allocated to groups receiving either intervention or nonintervention. After implementation of an antimicrobial stewardship program, the day from the onset of infection required to administer effective intravenous antimicrobial treatment was significantly shortened (p=0.022), and the rate of de-escalation was significantly elevated (p<0.001) compared with the nonintervention group. Further, the rate of 30-d death associated with bloodstream infection was siginificantly reduced from 11.4 to 5.4% (p=0.030) compared with the nonintervention group. The incidence of adverse events was significantly lower in the intervention group than in the nonintervention group (7.7 vs. 28.0%, p<0.001). Our present findings suggest that daily review of the use of antimicrobials was highly effective for optimizing early antimicrobial therapy and improved clinical outcomes of patients with bloodstream infections.
authors.affiliation: Department of Pharmacy, Gifu University Hospital.
authors.forename: Takashi
authors.initials: T
authors.lastname: Niwa
authors.forename: Tamayo
authors.initials: T
authors.lastname: Watanabe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Goto
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Ohta
authors.forename: Asami
authors.initials: A
authors.lastname: Nakayama
authors.forename: Keiko
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Shinoda
authors.forename: Mayumi
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: Koji
authors.initials: K
authors.lastname: Yasuda
authors.forename: Nobuo
authors.initials: N
authors.lastname: Murakami
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Itoh
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001419:Bacteria / Q000302:isolation & purification; D016903:Drug Monitoring; D004363:Drug Utilization; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D000900:Anti-Bacterial Agents