TABLE 4

Antimicrobial use during the first 96 h after blood culture collectiong

ParameterValue(s)
Control (n = 115)Stewardship (n = 104)BCID (n = 145)P
Antibiotic therapy modification in first 96 h
    De-escalation of any antimicrobial therapyc39 (33.9)59 (56.7)a76 (52.4)a0.001
    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,b0.03
Antibiotic therapy in the first 96 h
    Receipt of an anti-MRSA agentd74 (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 agente71 (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 agentf28 (24.3)48 (46.2)a60 (41.3)a0.002
    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)a0.02
    Receipt of fluoroquinolone39 (33.9)5 (4.8)a11 (7.5)a<0.001
Antimicrobial resistance (no. of documented nonsusceptible strains)
    Ceftriaxone534
    Fluoroquinolone (ciprofloxacin)9811
    Cefepime315
    Meropenem001
    Piperacillin-tazobactam518
  • 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.