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Impact of Antibiotic Stewardship Rounds in the Intensive Care Setting: A Prospective Cluster-Randomized Crossover

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Dedicated antibiotic stewardship rounds (ASRs) in intensive care units (ICUs) showed a small reduction in antibiotic use (AU). However, a significant AU decline occurred post-study, suggesting indirect ASR effects and the need for tailored interventions.

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Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Health Services Research

Background:

  • Limited formal studies exist on the impact of dedicated antibiotic stewardship rounds (ASRs) on antibiotic use (AU) within intensive care units (ICUs).
  • Understanding the effectiveness of ASRs is crucial for optimizing antimicrobial therapy in critically ill patients.

Purpose of the Study:

  • To evaluate the effect of weekly multidisciplinary antibiotic stewardship rounds (ASRs) on antibiotic use (AU) in intensive care units (ICUs).
  • To assess changes in AU during and after the implementation of ASRs in a real-world hospital setting.

Main Methods:

  • A 2-arm, cluster-randomized, crossover study was conducted in 5 ICUs over 8 months.
  • Antibiotic use (AU) was compared between patients exposed to ASRs and control patients, with exclusions for those off antibiotics or with high complexity markers.
  • Data on reviews, recommendations, and responses were recorded to evaluate changes in ICU-specific AU.

Main Results:

  • The study included 4683 patients, with 761 reviews conducted during ASRs, leading to the exclusion of 1569 patients (60% off antibiotics, 8% complex).
  • Overall AU rate ratio was 0.97; however, excluding the cardiothoracic ICU (CTICU) showed a reduction (RR 0.93).
  • A significant 16% decrease in AU was observed in the post-study period, with differential effects across ICUs, notably a 28% reduction in the neurology ICU.

Conclusions:

  • Weekly multidisciplinary ASRs represent a high-resource intervention associated with a modest direct reduction in AU.
  • The observed decline in ICU AU over time may be attributed to indirect effects of the ASRs.
  • Tailoring ASRs to specific ICU populations, workflows, and cultures is essential for maximizing impact.