Clinical impact of non-antibiotic recommendations by a multi-disciplinary antimicrobial stewardship team.

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Clinical impact of non-antibiotic recommendations by a multi-disciplinary antimicrobial stewardship team.

Int J Antimicrob Agents. 2017 Jun 15;:

Authors: Ng TM, Phang VY, Young B, Tan SH, Tay HL, Tan MW, Ling LM, Ang BS, Teng CB, Lye DC

Abstract
INTRODUCTION: The multi-disciplinary antimicrobial stewardship team at the study hospital conducts prospective review and feedback on all inpatient orders of piperacillin-tazobactam and carbapenems. In addition, the team provides non-antibiotic recommendations (i.e. additional investigations and infectious disease reviews). This study aimed to describe the impact of these recommendations on patient outcomes.
METHODS: Patients on carbapenem and piperacillin-tazobactam who received at least one non-antibiotic recommendation between January 2012 and August 2014 were included in this study. Acceptance and rejection of non-antibiotic recommendations by the managing physician were compared. The primary outcome was 30-d mortality.
RESULTS: Non-antibiotic recommendations were made in 166 patients. There were no differences in baseline characteristics between patients for whom recommendations were accepted and patients for whom recommendations were rejected. Thirty-day mortality (18.0% vs. 34.5%, P=0.02) was significantly lower in patients who had at least one non-antibiotic recommendation accepted. Multi-variate analysis found that Charlson's comorbidity score [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.03-1.42, P=0.03], APACHE II score (OR 1.10, 95% CI 1.01-1.19, P<0.01), hepatobiliary source of infection (OR 10.19, 95% CI 1.44-72.13, P=0.02) and acceptance of at least one non-antibiotic recommendation (OR 0.39, 95% CI 0.17-0.88, P=0.02) were independently associated with 30-d mortality.
CONCLUSIONS: During prospective review and feedback of piperacillin-tazobactam and carbapenems, acceptance of non-antibiotic recommendations was found to be associated with a reduction in 30-d mortality.

PMID: 28625717 [PubMed - as supplied by publisher]

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