Impact of a Pro-Active Infectious Disease Consultation on the Management of a Multidrug-Resistant Organisms Outbreak in a COVID-19 Hospital: A Three-Months Quasi-Experimental Study
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Published on: August 30, 2018
Davide Fiore Bavaro1, Nicolò De Gennaro1, Alessandra Belati1
1Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124 Bari, Italy.
Background:
Antimicrobial and diagnostic stewardship (AS/DS) principles are crucial for the management of multidrug-resistant organisms (MDROs) infections. We evaluated the impact of a pro-active Infectious Disease (ID) consultation on the mortality risk of patients during an MDROs outbreak in a COVID-19 hospital.
Methods:
A quasi-experimental study was performed in a dedicated COVID-19 hospital, including patients with suspected/confirmed infection and/or colonization by MDROs, which were managed as follows: (i) according to the standard of care during the pre-phase and (ii) in collaboration with a dedicated ID team performing a pro-active bedside evaluation every 48-72 h in the post-phase.
Results:
Overall, 112 patients were included (pre-phase = 89 and post-phase = 45). The AS interventions included the following: therapy optimization (33%), de-escalation to narrow the spectrum (24%) or to lessen toxic drugs (20%), and discontinuation of antimicrobials (64%). DS included the request of additional microbiologic tests (82%) and instrumental exams (16%). With the Cox model, after adjusting for age, sex, COVID-19 severity, infection source, etiological agents, and post-phase attendance, only age predicted an increased risk of mortality, while attendance in the post-phase resulted in a decreased risk of mortality.
Conclusions:
Implementation of AS and DS intervention through a pro-active ID consultation may reduce the risk of 28-day mortality of COVID-19 patients with MDROs infections.
Insights
Pro-active Infectious Disease (ID) consultation reduced mortality risk in COVID-19 patients with multidrug-resistant organism (MDRO) infections. This antimicrobial stewardship (AS) and diagnostic stewardship (DS) approach improved patient outcomes during an MDRO outbreak.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Stewardship
Background:
- Multidrug-resistant organisms (MDROs) pose significant challenges in healthcare settings, particularly during outbreaks.
- Antimicrobial stewardship (AS) and diagnostic stewardship (DS) are critical for managing MDRO infections.
- COVID-19 pandemic created unique challenges for infection control and patient management.
Purpose of the Study:
- To evaluate the impact of proactive Infectious Disease (ID) consultation on mortality risk in COVID-19 patients with MDRO infections.
- To assess the effectiveness of integrated AS and DS interventions during an MDRO outbreak in a dedicated COVID-19 hospital.
Main Methods:
- A quasi-experimental study design was employed in a COVID-19 hospital.
- Patients with suspected/confirmed MDRO infection or colonization were managed under standard care (pre-phase) and with dedicated ID team consultation (post-phase).
- Proactive bedside evaluations by the ID team were conducted every 48-72 hours in the post-phase.
Main Results:
- 112 patients were included; 89 in the pre-phase and 45 in the post-phase.
- AS interventions included therapy optimization, de-escalation, and discontinuation of antimicrobials.
- DS interventions involved requesting additional microbiologic and instrumental exams.
- Cox regression analysis indicated that post-phase attendance significantly decreased mortality risk, while only age predicted increased mortality.
Conclusions:
- Proactive Infectious Disease consultation, integrating AS and DS, can effectively reduce 28-day mortality in COVID-19 patients with MDRO infections.
- This approach demonstrates the value of specialized infectious disease expertise in managing complex patient populations during outbreaks.
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