Impact of an antimicrobial stewardship initiative on time to administration of empirical antibiotic therapy in hospitalized patients with bacteremia.
| Autor: | Bias TE; Department of Pharmacy, Hahnemann University Hospital, Philadelphia, PA. bias.tiffany@gmail.com., Vincent WR 3rd; Department of Pharmacy, Boston Medical Center, Boston, MA., Trustman N; Department of Pharmacy, Coney Island Hospital, Brooklyn, NY., Berkowitz LB; Division of Infectious Diseases, Brooklyn Hospital Center, Brooklyn, NY., Venugopalan V; Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, FL. |
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| Jazyk: | angličtina |
| Zdroj: | American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists [Am J Health Syst Pharm] 2017 Apr 01; Vol. 74 (7), pp. 511-519. |
| DOI: | 10.2146/ajhp160096 |
| Abstrakt: | Purpose: 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, Bacillus species). 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. Conclusion: 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. (Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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