Can a collaborative subspecialty antimicrobial stewardship intervention have lasting effects?

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Hospital Administration

Background:

• Direct, daily collaboration between infectious disease (ID) and critical care practitioners (CCP) previously improved guideline adherence and antibiotic use in the medical intensive care unit (MICU).
• The sustainability of these improvements was not previously established.

Purpose of the Study:

• To determine if the positive effects of ID and CCP collaboration on antibiotic use and guideline adherence in the MICU were sustainable.
• To assess antibiotic appropriateness and usage patterns at 3 and 6 months post-intervention.

Main Methods:

• A retrospective review of 87 patients admitted to the MICU was conducted.
• Data collected included patient demographics, severity indicators, and clinical outcomes such as mechanical ventilation days (MVD), MICU length of stay (LOS), antibiotic days of therapy (DOT), and in-hospital mortality.
• Antibiotic appropriateness was evaluated based on current guidelines.

Main Results:

• No significant differences in APACHE II scores, MVD, LOS, DOT, or total antibiotic use were observed at 3 or 6 months post-intervention.
• While vancomycin usage initially decreased at 3 months post-intervention, this difference was not significant at 6 months.
• Antibiotic inappropriateness remained unchanged at both 3 and 6 months post-intervention compared to the intervention period.

Conclusions:

• Continuous, daily collaboration between ID and CCP can lead to lasting improvements in antibiotic stewardship.
• The positive impact on antibiotic use and guideline adherence can be sustained for at least six months after the collaborative intervention has ended.