Automatic day-2 intervention by a multidisciplinary antimicrobial stewardship-team leads to multiple positive effects

作者：Dik Jan Willem H; Hendrix Ron; Lo Ten Foe Jerome R; Wilting Kasper R; Panday Prashant N; van Gemert Pijnen Lisette E; Leliveld Annemarie M; van der Palen Job; Friedrich Alex W^*; Sinha Bhanu

来源：Frontiers in Microbiology, 2015, 6: 546.

DOI：10.3389/fmicb.2015.00546

• A-Teams
• antimicrobial prescription
• antimicrobial stewardship
• antimicrobial resistance
• intervention study

Background: Antimicrobial resistance rates are increasing. This is, among others, caused by incorrect or inappropriate use of antimicrobials. To target this, a multidisciplinary antimicrobial stewardship-team (A-Team) was implemented at the University Medical Center Groningen on a urology ward. Goal of this study is to evaluate the clinical effects of the case-audits done by this team, looking at length of stay (LOS) and antimicrobial use.
Methods: Automatic e-mail alerts were sent after 48 h of consecutive antimicrobial use triggering the case-audits, consisting of an A-Team member visiting the ward, discussing the patient's therapy with the bed-side physician and together deciding on further treatment based on available diagnostics and guidelines. Clinical effects of the audits were evaluated through an Interrupted Time Series analysis and a retrospective historic cohort.
Results: A significant systemic reduction of antimicrobial consumption for all patients on the ward, both with and without case-audits was observed. Furthermore, LOS for patients with case-audits who were admitted primarily due to infections decreased to 6.20 days (95% CI: 5.59-6.81) compared to the historic cohort (7.57 days; 95% CI: 6.92-8.21; p = 0.012). Antimicrobial consumption decreased for these patients from 8.17 DDD/patient (95% CI: 7.10-9.24) to 5.93 DDD/patient (95% CI: 5.02-6.83; p = 0.008). For patients with severe underlying diseases (e.g., cancer) these outcome measures remained unchanged.
Conclusion: The evaluation showed a considerable positive impact. Antibiotic use of the whole ward was reduced, transcending the intervened patients. Furthermore, LOS and mean antimicrobial consumption for a subgroup was reduced, thereby improving patient care and potentially lowering resistance rates.

• 出版日期2015-6-3