Antimicrobial use during the first 96 h after blood culture collectiong
| Parameter | Value(s) | |||
|---|---|---|---|---|
| Control (n = 115) | Stewardship (n = 104) | BCID (n = 145) | P | |
| Antibiotic therapy modification in first 96 h | ||||
| De-escalation of any antimicrobial therapyc | 39 (33.9) | 59 (56.7)a | 76 (52.4)a | 0.001 |
| Time to first antimicrobial de-escalation, h, median (IQR) (n = 174) | 63.0 (43.6–73.6) | 60.5 (44.8–70.4) | 48.1 (24.3–69.3)a,b | 0.03 |
| Antibiotic therapy in the first 96 h | ||||
| Receipt of an anti-MRSA agentd | 74 (64.3) | 66 (63.4) | 79 (54.5) | 0.20 |
| Duration of anti-MRSA therapy, h, median (IQR) (n = 219) | 62.7 (45.6–83.0) | 56.4 (32.3–82.0) | 60 (30.7–84.0) | 0.62 |
| Receipt of an antipseudomonal β-lactam agente | 71 (61.7) | 70 (67.3) | 106 (73.1) | 0.15 |
| Duration of anti-pseudomonal β-lactam, h, median (IQR) (n = 247) | 60.6 (39.9–84.7) | 51.5 (32.4–76.3) | 63.1 (29.7–90.1) | 0.26 |
| Receipt of narrow-spectrum β-lactam agentf | 28 (24.3) | 48 (46.2)a | 60 (41.3)a | 0.002 |
| Duration of narrow-spectrum β-lactam, h, median (IQR) (n = 136) | 26.9 (23.2–56.6) | 35.0 (24.3–70.2) | 52.6 (25.4–75.4)a | 0.02 |
| Receipt of fluoroquinolone | 39 (33.9) | 5 (4.8)a | 11 (7.5)a | <0.001 |
| Antimicrobial resistance (no. of documented nonsusceptible strains) | ||||
| Ceftriaxone | 5 | 3 | 4 | |
| Fluoroquinolone (ciprofloxacin) | 9 | 8 | 11 | |
| Cefepime | 3 | 1 | 5 | |
| Meropenem | 0 | 0 | 1 | |
| Piperacillin-tazobactam | 5 | 1 | 8 | |
↵a Statistically significant compared to control group.
↵b Statistically significant comparison between the 2 intervention groups.
↵c De-escalation was defined as cessation of treatment with 1 or more antibiotics and/or switching to an antibiotic with a narrower spectrum of activity.
↵d Anti-MRSA therapy included vancomycin, daptomycin, or linezolid therapy.
↵e Antipseudomonal β-lactams included cefepime, ceftazidime, doripenem, imipenem-cilastatin, meropenem, and piperacillin-tazobactam.
↵f Narrow-spectrum β-lactams were defined as β-lactams devoid of antipseudomonal activity.
↵g Data are presented as number (percent) of patients, unless specified otherwise. Abbreviations: BCID, blood culture identification panel; IQR, interquartile range; MRSA, methicillin-resistant S. aureus.