Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by...

Area of Science:

• Infectious Diseases
• Clinical Pharmacy
• Critical Care Medicine

Background:

• Sepsis remains a leading cause of mortality worldwide.
• Optimizing antimicrobial therapy is crucial for improving patient outcomes in sepsis.
• Antimicrobial stewardship programs (ASPs) play a vital role in guiding appropriate antimicrobial use.

Purpose of the Study:

• To identify key factors for antimicrobial stewardship teams to focus on in treating sepsis patients.
• To investigate the relationship between antimicrobial use and 30-day mortality in sepsis patients over a 10-year period.

Main Methods:

• A retrospective analysis of 1406 patients with pathogen-identified sepsis at Hirosaki University Hospital.
• Hierarchical multiple logistic regression was used to identify factors associated with 30-day mortality.
• Evaluation included clinical data, microbiological data, empiric and definitive antimicrobial therapies, and de-escalation practices.

Main Results:

• Ineffective empiric antimicrobial use (OR=2.70), and ineffective or underdosed definitive therapy (OR=3.72, 3.65) were significantly linked to increased 30-day mortality.
• Multiple blood culture sampling showed an inverse association with inappropriate antimicrobial use.
• A yearly decrease in 30-day mortality correlated with increased blood cultures and de-escalation, alongside reduced inappropriate antimicrobial use.

Conclusions:

• Multiple blood culture sampling, appropriate antimicrobial selection, and adequate dosing in definitive therapy can reduce sepsis-related 30-day mortality.
• These factors represent key areas for antimicrobial stewardship teams to support and implement.
• Optimizing antimicrobial strategies is essential for improving survival rates in sepsis patients.