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. 2015 Jun 3:6:546.
doi: 10.3389/fmicb.2015.00546. eCollection 2015.

Automatic day-2 intervention by a multidisciplinary antimicrobial stewardship-team leads to multiple positive effects

Jan-Willem H Dik  1 , Ron Hendrix  2 , Jerome R Lo-Ten-Foe  1 , Kasper R Wilting  1 , Prashant N Panday  3 , Lisette E van Gemert-Pijnen  4 , Annemarie M Leliveld  5 , Job van der Palen  6 , Alex W Friedrich  1 , Bhanu Sinha  1
Affiliations

Automatic day-2 intervention by a multidisciplinary antimicrobial stewardship-team leads to multiple positive effects

Jan-Willem H Dik et al. Front Microbiol. .

Abstract

Background: Antimicrobial resistance rates are increasing. This is, among others, caused by incorrect or inappropriate use of antimicrobials. To target this, a multidisciplinary antimicrobial stewardship-team (A-Team) was implemented at the University Medical Center Groningen on a urology ward. Goal of this study is to evaluate the clinical effects of the case-audits done by this team, looking at length of stay (LOS) and antimicrobial use.

Methods: Automatic e-mail alerts were sent after 48 h of consecutive antimicrobial use triggering the case-audits, consisting of an A-Team member visiting the ward, discussing the patient's therapy with the bed-side physician and together deciding on further treatment based on available diagnostics and guidelines. Clinical effects of the audits were evaluated through an Interrupted Time Series analysis and a retrospective historic cohort.

Results: A significant systemic reduction of antimicrobial consumption for all patients on the ward, both with and without case-audits was observed. Furthermore, LOS for patients with case-audits who were admitted primarily due to infections decreased to 6.20 days (95% CI: 5.59-6.81) compared to the historic cohort (7.57 days; 95% CI: 6.92-8.21; p = 0.012). Antimicrobial consumption decreased for these patients from 8.17 DDD/patient (95% CI: 7.10-9.24) to 5.93 DDD/patient (95% CI: 5.02-6.83; p = 0.008). For patients with severe underlying diseases (e.g., cancer) these outcome measures remained unchanged.

Conclusion: The evaluation showed a considerable positive impact. Antibiotic use of the whole ward was reduced, transcending the intervened patients. Furthermore, LOS and mean antimicrobial consumption for a subgroup was reduced, thereby improving patient care and potentially lowering resistance rates.

Keywords: A-Teams; antimicrobial prescription; antimicrobial resistance; antimicrobial stewardship; intervention study.

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Figures

FIGURE 1
FIGURE 1
Interventions performed. Distribution of the interventions performed for alert patients, subdivided into the two Groups. Percentages of interventions refer to the total number done within the 75% of intervened patients, where one patient can receive multiple interventions.
FIGURE 2
FIGURE 2
Antimicrobial stewardship-team (A-Team) effects on the whole ward. (A) trends of percentages of all patients on the ward receiving antibiotics with and without intervention(s) and respective DDDs per 100 patient days. Shown are 2 years before the intervention started (June 2013), until June 2014, including trend lines and predicted trend lines. A second dotted trend line for the mean DDDs depicts the trend without the outlier patient from April 2014 (∗). (B) predicted and measured percentages of users at three different time points with their respective p-values, calculated with an interrupted time series analysis. (C) predicted and measured consumption with their respective p-values, on the same three time points with the same interrupted time series analysis. (∗) The peak in the month April is caused by a single patient who received correct but extensive small spectrum oral antibiotic treatment for a deep-seated, complicated infection.
FIGURE 3
FIGURE 3
Kaplan–Meier plots of length of stay (LOS). Percentages of patients’ days of discharge. Group 1 intervention patients compared to the historic cohort group 1 (A) with Group two patients as insert (B). Significance was tested with a Log–Rank test (Mantel–Cox).
See this image and copyright information in PMC

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