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Effects of a bundled Antimicrobial Stewardship Program on mortality: a cohort study.
- Source :
-
The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases [Braz J Infect Dis] 2015 May-Jun; Vol. 19 (3), pp. 246-52. Date of Electronic Publication: 2015 Apr 17. - Publication Year :
- 2015
-
Abstract
- Objectives: To assess a bundled Antimicrobial Stewardship Program and its effect on mortality.<br />Data: Eight months of clinical electronic medical records and Antimicrobial Stewardship Program registries were used as source of data.<br />Method: This is a historical cohort study conducted in a Brazilian University Hospital. Eligible patients were admitted to general wards or intensive care units and had an antimicrobial therapy prescribed and assessed by different strategies: Bundled Antimicrobial Stewardship Program (bundled intervention consisted of clinical pharmacist chart review, discussion with microbiologist and infectious disease physicians, local education and continuous follow-up) or Conventional Antimicrobial Stewardship Program (clinical pharmacist chart review and discussion with infectious disease physician). Primary outcome from this study was 30-day mortality, which was compared between groups, by using Kaplan-Meier survival curve and log-rank test. Other outcomes included Defined Daily Doses per 1000 patient-days and occurrence of resistant bacteria.<br />Results: From 533 patients, 491 were eligible for the study, of which 191 patients were included to Antimicrobial Stewardship Program and 300 to Conventional strategy. In general, they were likely to be male and age was similar in groups (58.9 vs 55.5 years, p=0.38). Likewise, Charlson Comorbidity Index was not statistically different between groups (2.6 vs 2.7, p=0.2). Bloodstream site infections were frequently diagnosed in both groups (30.89% vs 26%, p=0.24). Other less common sites of infections were central nervous system and lungs. The ASP group had higher survival rates (p<0.01) and the risk difference was 10.8% (95% CI: 2.41-19.14). There were less Defined Daily Doses per 1000 patient-days (417 vs 557.2, p<0.05) and higher rates of resistant bacteria identified in the ASP group (83% vs 17%).<br />Conclusion: Bundled ASP was the most effective strategy, with reduced mortality and Defined Daily Doses per 1000 patient-days.<br /> (Copyright © 2015 Elsevier Editora Ltda. All rights reserved.)
- Subjects :
- Bacterial Infections microbiology
Brazil
Cohort Studies
Drug Administration Schedule
Female
Hospital Mortality
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Retrospective Studies
Anti-Bacterial Agents administration & dosage
Bacterial Infections drug therapy
Outcome Assessment, Health Care
Pharmacy Service, Hospital
Subjects
Details
- Language :
- English
- ISSN :
- 1678-4391
- Volume :
- 19
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 25892314
- Full Text :
- https://doi.org/10.1016/j.bjid.2015.02.005