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Published on: August 30, 2018
Prospective antimicrobial audit and feedback did not decrease case fatality: Experiences from a hospital in northern
Chien-Yu Cheng1, Chien-Yu Lee, Min-Wen Wu
1Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan. vajien@mail.tygh.gov.tw.
Introduction:
Although a prospective antimicrobial audit and feedback is an effective strategy in an antibiotic stewardship program, previous researchers have not adequately demonstrated a successful impact on patient outcomes. In this study, the causes of fatalities associated with a prospective antimicrobial audit and feedback were analyzed.
Methodology:
Between June and September 2014, applications for 16 target parenteral formulas (including ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, vancomycin, teicoplanin, ertapenem, imipenem/cilastatin, meropenem, levofloxacin, moxifloxacin, ciprofloxacin, tigecycline, linezolid, daptomycin, and amikacin), which were not approved by infectious diseases (ID) specialists, were followed up until patients were either discharged or passed away.
Results:
Of the 292 cases studied, 193 (66%) were male, with a mean age (standard deviation) of 65.5 (19.3) years. There were five reasons for rejection, including dosage adjustments (37%), no evidence of bacterial infection (28.8%), modifications according to antimicrobial susceptibility (18.8%), target pathogens not being covered (7.2%), and redundant therapy (4.1%). Multiple logistic regression analysis demonstrated that an age greater than 75 years (odds ratio [OR]: 2.58; 95% confidence interval [CI]: 1.32-5.50; p = 0.005) was associated with significant mortality, while urinary tract (OR: 0.26; 95% CI: 0.09-0.70; p = 0.013) and soft tissue/bone infections (OR: 0.18; 95% CI: 0.05-0.61; p = 0.006) were associated with survival. Adjustments according to ID physicians' recommendations were not statistically significant (OR: 0.53; 95% CI: 0.27-1.06; p = 0.074).
Conclusions:
Antimicrobial adjustments according to ID physicians' recommendations showed only marginally preventative effects against fatalities.
Insights
Prospective antimicrobial audit and feedback can impact patient outcomes. This study analyzed fatalities, finding age over 75 and specific infections influenced mortality and survival rates.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Critical Care Medicine
Background:
- Prospective antimicrobial audit and feedback is a key antibiotic stewardship program strategy.
- Previous studies have not conclusively linked this strategy to improved patient outcomes.
- This research investigates the causes of mortality in patients undergoing such audits.
Purpose of the Study:
- To analyze the causes of fatalities associated with prospective antimicrobial audit and feedback.
- To identify patient factors and infection types influencing outcomes in antibiotic stewardship.
- To evaluate the effectiveness of infectious diseases (ID) specialist recommendations on mortality.
Main Methods:
- A retrospective analysis of 292 parenteral formula applications not approved by ID specialists.
- Data collection included patient demographics, infection types, and reasons for application rejection.
- Follow-up until patient discharge or death to ascertain outcomes.
Main Results:
- Mortality was significantly associated with age greater than 75 years (OR: 2.58).
- Urinary tract and soft tissue/bone infections were associated with patient survival (OR: 0.26 and 0.18, respectively).
- Reasons for rejection included dosage adjustments (37%) and lack of bacterial infection evidence (28.8%).
Conclusions:
- Antimicrobial adjustments based on ID physician recommendations demonstrated only marginal preventative effects against fatalities.
- Patient age and infection site are significant factors in mortality and survival.
- Further research is needed to optimize antibiotic stewardship interventions for improved patient outcomes.
