title: Prospective antimicrobial audit and feedback did not decrease case fatality: Experiences from a hospital in northern Taiwan.
abstract: BACKGROUND
  Although a prospective antimicrobial audit and feedback is an effective strategy in an antibiotic stewardship program, previous researchers have not adequately demonstrated a successful impact on patient outcomes. In this study, the causes of fatalities associated with a prospective antimicrobial audit and feedback were analyzed.
  
  
  METHODS
  Between June and September 2014, applications for 16 target parenteral formulas (including ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, vancomycin, teicoplanin, ertapenem, imipenem/cilastatin, meropenem, levofloxacin, moxifloxacin, ciprofloxacin, tigecycline, linezolid, daptomycin, and amikacin), which were not approved by infectious diseases (ID) specialists, were followed up until patients were either discharged or passed away.
  
  
  RESULTS
  Of the 292 cases studied, 193 (66%) were male, with a mean age (standard deviation) of 65.5 (19.3) years. There were five reasons for rejection, including dosage adjustments (37%), no evidence of bacterial infection (28.8%), modifications according to antimicrobial susceptibility (18.8%), target pathogens not being covered (7.2%), and redundant therapy (4.1%). Multiple logistic regression analysis demonstrated that an age greater than 75 years (odds ratio [OR]: 2.58; 95% confidence interval [CI]: 1.32-5.50; p = 0.005) was associated with significant mortality, while urinary tract (OR: 0.26; 95% CI: 0.09-0.70; p = 0.013) and soft tissue/bone infections (OR: 0.18; 95% CI: 0.05-0.61; p = 0.006) were associated with survival. Adjustments according to ID physicians' recommendations were not statistically significant (OR: 0.53; 95% CI: 0.27-1.06; p = 0.074).
  
  
  CONCLUSIONS
  Antimicrobial adjustments according to ID physicians' recommendations showed only marginally preventative effects against fatalities.
authors.affiliation: Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan. vajien@mail.tygh.gov.tw.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Cheng
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Lee
authors.forename: Min-Wen
authors.initials: MW
authors.lastname: Wu
authors.forename: Chen-Hung
authors.initials: CH
authors.lastname: Chang
authors.forename: Wan-Ying
authors.initials: WY
authors.lastname: Huang
authors.forename: Yi-Fen
authors.initials: YF
authors.lastname: Chuang
authors.forename: Pei-Hsin
authors.initials: PH
authors.lastname: Tang
authors.forename: Shu-Hsing
authors.initials: SH
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000401:mortality*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents