Potential interventions for an antimicrobial stewardship bundle for Escherichia coli bacteraemia

Area of Science:

• Infectious Diseases
• Antimicrobial Stewardship
• Clinical Microbiology

Background:

• Escherichia coli is a leading cause of bacteraemia with diverse clinical presentations.
• Variable antimicrobial therapy is common in E. coli bacteraemia due to the range of associated diseases.
• Optimizing antimicrobial use is crucial for effective treatment and combating resistance.

Purpose of the Study:

• To evaluate the workload and efficiency of an antimicrobial stewardship (AMS) bundle approach for E. coli bacteraemia.
• To assess the potential impact of AMS interventions on antimicrobial therapy duration and optimization.
• To identify opportunities for improving E. coli bacteraemia management through a bundled AMS strategy.

Main Methods:

• Observational cohort study of patients with E. coli bacteraemia.
• Comprehensive review of medical records for each case.
• Modeling of various AMS interventions to assess impact on therapy days and optimization time.

Main Results:

• 566 episodes of E. coli bacteraemia were analyzed.
• Strict guideline adherence increased ineffective empirical therapy (14.3% vs 10.2%).
• A Day 3 AMS review could lead to narrower-spectrum IV antibiotics in 46% of cases and reduce therapy duration by a median of 7 days in 68.2% of patients.

Conclusions:

• A large cohort of E. coli bacteraemia patients was described.
• Significant variability exists in empirical treatment, step-down therapy, and duration.
• AMS programs using a bundled approach present a substantial opportunity to improve E. coli bacteraemia management.