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A 72-h intervention for improvement of the rate of optimal antibiotic therapy in patients with bloodstream infections

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Antimicrobial stewardship programs are implemented to optimize the use of antibiotics and control the spread of antibiotic resistance. Many antimicrobial stewardship interventions have demonstrated significant efficacy in reducing unnecessary prescriptions of antibiotics, the duration of antimicrobial therapy, and mortality. We evaluated the benefits of a combination of rapid diagnostic tests and an active re-evaluation of antibiotic therapy 72 h after the onset of bloodstream infection (BSI). All patients with BSI from November 2015 to November 2016 in a 1100-bed university hospital in Rome, where an Infectious Disease Consultancy Unit (Unità di Consulenza Infettivologica, UDCI) is available, were re-evaluated at the bedside 72 h after starting antimicrobial therapy and compared to two pre-intervention periods: the UDCI was called by the ward physician for patients with BSI and the UDCI was called directly by the microbiologist immediately after a pathogen was isolated from blood cultures. Recommendations for antibiotic de-escalation or discontinuation significantly increased (54%) from the two pre-intervention periods (32% and 27.2%, p < 0.0001). Appropriate escalation also significantly increased (22.5%) from the pre-intervention periods (8.1% and 8.2%, p < 0.0001). The total duration of antibiotic therapy decreased with intervention (from 21.9 days [standard deviation, SD 15.4] in period 1 to 19.3 days [SD 13.3] in period 2 to 17.7 days in period 3 [SD 11.5]; p = 0.002) and the length of stay was significantly shorter (from 29.7 days [SD 29.3] in period 1 to 26.8 days [SD 24.7] in period 2 to 24.2 days in period 3 [SD 20.7]; p = 0.04) than in the two pre-intervention periods. Mortality was similar among the study periods (31 patients died in period 1 (15.7%), 39 (16.7%) in period 2, and 48 (15.3%) in period 3; p = 0.90). Rapid diagnostic tests and 72 h re-evaluation of empirical therapy for BSI significantly correlated with an improved rate of optimal antibiotic therapy and decreased duration of antibiotic therapy and length of stay.

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Acknowledgements

We are grateful to Leonida Passeri for his technical assistance in the data management.

Funding

No funding was received for this study. The present manuscript was revised by San Francisco Edit, which was supported by internal funding.

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Authors and Affiliations

  1. Department of Infectious Diseases, Catholic University of Rome, Rome, Italy

    R. Murri, F. Taccari, I. Mastrorosa, F. Giovannenze, G. Scoppettuolo, G. Ventura, C. Palazzolo, M. Camici, S. Lardo, R. Cauda & M. Fantoni

  2. Department of Microbiology, Catholic University of Rome, Rome, Italy

    T. Spanu, T. D’Inzeo, B. Fiori & M. Sanguinetti

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  1. R. Murri
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  2. F. Taccari
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  3. T. Spanu
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  6. F. Giovannenze
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  14. R. Cauda
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Correspondence to R. Murri.

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The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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No ethical approval and no informed consent were required since the intervention is part of clinical routine activity.

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Murri, R., Taccari, F., Spanu, T. et al. A 72-h intervention for improvement of the rate of optimal antibiotic therapy in patients with bloodstream infections. Eur J Clin Microbiol Infect Dis 37, 167–173 (2018). https://doi.org/10.1007/s10096-017-3117-2

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  • DOI: https://doi.org/10.1007/s10096-017-3117-2

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