Do antimicrobial stewardship programs improve the quality of care in ICU patients diagnosed with infectious diseases following consultation Experience in a tertiary care hospital.

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Introduction

One of the most important public health concerns is the ever-growing problem of antibiotic resistance. Importantly, the rate at which new molecules are introduced into clinical practise has slowed significantly. Furthermore, the rapid emergence of resistance reduces the molecules’ effective lifespan. In the ICUs of Hacettepe University Adult and Oncology Hospitals, the quality of care before and after active intervention and feedback was assessed in patients diagnosed with sepsis/septic shock or ventilator-associated pneumonia (VAP).

Methods

This quasi-experimental study was conducted in patients diagnosed with sepsis/septic shock or VAP, who were hospitalized in seven ICUs accounting for a total of 138 beds in a tertiary care university hospital. The consulting ID team was notified as soon as the primary physician suspected sepsis/septic shock or VAP in a patient. Antimicrobial agents were ordered via the hospital intranet by the primary physician, stating with the route of administration, dose, dosing intervals, and special requirements if needed, such as the duration of infusion. The antibiotic was released for use from an automated medication dispensing system (the BD™ Pyxis MedStation™ ES) in the ICU following ID physician approval. The primary endpoint of the study was total quality-control scores for management of sepsis/septic shock and VAP, developed by the ID staff.

Study population

In total, 150 patients — 50 for each period — were included in the study. Patients who were at least 18 years of age, were hospitalized in the relevant ICUs, and started empirical antibiotics for sepsis/septic shock or VAP were included in the study.

Evaluation process

The clinical conditions of the patients were evaluated on the first day of treatment, after 72 hours, at the end of the optimal treatment period, and on the final day — when antimicrobials were discontinued. The collected data were scored according to Quality Control Scores for Management of Sepsis/Septic Shock and Quality Control Scores for Management of VAP, developed by the ID staff.

Results

Baseline patient characteristics

In total, 113 patients diagnosed with sepsis/septic shock (37 in period 1, 39 in period 2, & 37 in period 3) were included in the study. There were 37 patients with VAP in the study (13 in period 1, 11 in period 2, and 13 in period 3). These patients did not differ across the three periods in terms of gender (62.2% male, 37.8% female; p = 0.102), age (mean: 64.4 years ± 17.7 years; p = 0.67), or number of comorbidities (median: 3, range: 1–5; p = 0.25).

Time to the first dose of antibiotic

The median time from requesting ID consultation for suspected sepsis/septic shock to administration of the first dose of antibiotic was 179 minutes (IQR: 359 minutes) for period 1, 205 minutes (IQR: 334 minutes) for period 2, and 206 minutes (IQR: 342 minutes) for period 3 (p = 0.502).

Quality control parameters

The mean total quality-of-care scores for patients with sepsis/septic shock were 8.5 ± 3.76 in period 1, 9.91 ± 3.56 in period 2, and 14.94 ± 3.92 in period 3 (Table 4). There was a significant increase in total scores in period 3 (p < 0.001). Significant improvements were achieved in the management of these patients in period 3 in terms of requesting necessary diagnostic tests, and prolonged infusion of beta-lactam agents.

Patient outcome

The durations of ICU and hospital stay, mortality rates, superinfections with Candida spp. or Clostridium difficile, emergences of multidrug-resistant bacteria, and recurrences of sepsis/septic shock or VAP within 15 days were similar across the three study periods.

Conclusion

The implementation of ASPs in centers where antimicrobial management of ICU patients is largely controlled by infectious diseases specialists remains a feasible strategy for improving patient care.

Source:  NGamze GURSOY, Omrum UZUN, Gokhan METAN, Mehmet YILDIRIM, Melda BAHAP, Salih Kutay DEMIRKAN, Arzu TOPELI, Seda Banu AKINCI, Mehmet Akif TOPCUOGLU, Mustafa BERKER, Gulsen HAZIROLAN, Murat AKOVA, Serhat UNAL, Do antimicrobial stewardship programs improve the quality of care in ICU patients diagnosed with infectious diseases following consultation? Experience in a tertiary care hospital, International Journal of Infectious Diseases, Volume 115, 2022, Pages 201-207, ISSN 1201-9712, https://doi.org/10