Impact of an antimicrobial stewardship initiative on time to administration of empirical antibiotic therapy in hospitalized patients with bacteremia.
OBJECTIVE
The impact of an antimicrobial stewardship initiative on time to first antibiotic dose and clinical outcomes in bacteremic patients was evaluated.


METHODS
A single-center, retrospective study was conducted for adult inpatients who received antibiotics before and after implementation of a rapid administration of antimicrobials by an infectious diseases specialist (RAIDS) protocol. Patients admitted to an inpatient service from June to October 2011 (pre-RAIDS protocol) and from December 2011 to February 2012 (post-RAIDS protocol) were eligible for inclusion if (1) they were age 18 years or older, (2) their infection occurred two or more days after hospital admission, and (3) they had a blood culture growing an organism other than common skin contaminants (i.e., coagulase-negative staphylococci,Bacillusspecies). The primary outcome was the time to the first antibiotic dose (TFAD), defined as the time that elapsed from a positive blood culture result to administration of the first empirical antimicrobial dose.


RESULTS
A total of 111 bacteremic patients were included in the analysis. Implementation of the RAIDS protocol led to significantly faster antibiotic order entry, verification, and administration of empirical antibiotics in patients with bacteremia. The median TFAD was approximately 8 hours faster in the post-RAIDS group than in the pre-RAIDS group (9:09 hr:min versus 1:23 hr:min,p< 0.001). Patients in the post-RAIDS group had a significant reduction in infection-related mortality (p= 0.047), though all-cause 30-day mortality was similar.


CONCLUSIONS
Early notification of an infectious diseases pharmacist about positive blood cultures using the RAIDS protocol led to increased appropriateness of empirical drug selection and a dramatic reduction in the administration of antibiotics and was associated with decreased infection-related mortality.
Department of Pharmacy, Hahnemann University Hospital, Philadelphia, PA. bias.tiffany@gmail.com.
Tiffany E
TE
Bias
Department of Pharmacy, Boston Medical Center, Boston, MA.
William R
WR
Vincent
Department of Pharmacy, Coney Island Hospital, Brooklyn, NY.
Nathan
N
Trustman
Division of Infectious Diseases, Brooklyn Hospital Center, Brooklyn, NY.
Leonard B
LB
Berkowitz
Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL.
Veena
V
Venugopalan
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship / Q000379:methods / Q000706:statistics & numerical data*; D001407:Bacillus / Q000187:drug effects / Q000302:isolation & purification; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D000071997:Blood Culture / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015397:Program Evaluation; D012189:Retrospective Studies; D013210:Staphylococcus / Q000187:drug effects / Q000302:isolation & purification; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
antibiotic; antimicrobial stewardship; bacteremia; infectious diseases