Evaluation of initial antibiotic therapy for bacteremia and role of an antibiotic management team for antibiotic stewardship

Médecine et maladies infectieuses
S DiamantisJ-C Lucet

Abstract

Antibiotic management teams (AMTs) are recommended, but they are rarely implemented in France and their activity seldom evaluated. The study was made to evaluate the appropriateness of antibiotic therapy (AT) for bloodstream infections (BSI) and to assess the role of an AMT for improving AT in a 950-bed teaching hospital. A prospective analysis was made of all significant BSIs outside ICU in 2008. AT was assessed by the AMT and change was suggested if deemed necessary: effective if at least one prescribed antibiotic was effective in vitro, and appropriate if consistent with local recommendations. Of 875 +BCs, 560 were significant, 383 were outside ICU and 344 could be evaluated (170 community-acquired, 124 nosocomial, and 50 healthcare-associated [HCA]). The clinical ward has already initiated an effective and appropriate AT in 128 (37%), inappropriate but effective in 104 (30%), and ineffective or absent in 112 (33%) BSIs. The only independent variable associated with ineffective/absent AT was nosocomial and/or HCA BSI (aOR: 2.71; 95%CI: 1.72-4.27; p<0.001). A recommendation was given and followed in 177/190 (93%) BSIs requiring an intervention. The AMT intervened on the day of the +BC in 256 (84%) cases, the day before the +B...Continue Reading

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Aug 25, 2012·Interdisciplinary Perspectives on Infectious Diseases·Saoraya Lueangarun, Amorn Leelarasamee
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