Pharmacist-led antimicrobial stewardship program in the treatment of Staphylococcus aureus bacteraemia in paediatric patients: a multivariate analysis.

Autor:	Schenidt Bispo da Silva SC; Antimicrobial Stewardship Program, Pequeno Príncipe Hospital, Curitiba, PR, Brazil., Fachi MM; Value Management Office, Pequeno Príncipe Hospital, Curitiba, PR, Brazil., Ricieri MC; Antimicrobial Stewardship Program, Pequeno Príncipe Hospital, Curitiba, PR, Brazil., de Araújo Motta F; Antimicrobial Stewardship Program, Pequeno Príncipe Hospital, Curitiba, PR, Brazil.
Jazyk:	angličtina
Zdroj:	Infection prevention in practice [Infect Prev Pract] 2024 Nov 08; Vol. 6 (4), pp. 100419. Date of Electronic Publication: 2024 Nov 08 (Print Publication: 2024).
DOI:	10.1016/j.infpip.2024.100419
Abstrakt:	Background: Care bundles are a recognised strategy to improve treatment. When managed through an Antimicrobial Stewardship Program (ASP) based on the pharmacist-led program model, care bundles can be an effective tool to guide decision making in clinical practice and to improve patient outcomes. This study aimed to evaluate the results of a pharmacist-led ASP which included a care bundle based on clinical outcomes of Staphylococcus aureus bacteraemia (SAB) in a paediatric hospital. Methods: A retrospective cohort study with multivariate analysis was conducted in a paediatric hospital in Brazil. The study comprised 120 paediatric patients with a positive blood culture for S. aureus with occurred between 2014 and 2021 and clinical and laboratory results consistent with infection. The study was classified into two periods: pre-intervention (n=44) and intervention (n=76). A pharmacist-led ASP program with a care bundle was established during the intervention period 2017-2021. The primary outcome assessed was the impact on clinical outcomes, including infection-related mortality and 90-day reinfection rate, both being considered therapeutic failure. Results: The multivariate analysis demonstrated that the following variables had an impact on primary outcome: infant patients [Odds ratio (OR) 12.998, P =0.044]; use of more than three antimicrobial treatment regimens [OR 0.006, P =0.017]; intervention period [OR 0.060, P =0.034]; bundle item 1 - follow-up blood culture [OR 18.953, P =0.049]; bundle item 2 - early source control [OR 0.002, P =0.018]; bundle item 4 - de-escalation to oxacillin for methicillin-sensitive S. aureus [OR 0.041, P =0.046]. Conclusions: The pharmacist-led ASP model showed an increase in adherence to the care bundle between the two study periods, with reduced probability of a negative outcome. Furthermore, risk factors for S. aureus bacteraemia were identified that may inform management and contribute to better patient outcomes in the paediatric population. Competing Interests: None. (© 2024 The Authors.)
Databáze:	MEDLINE
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