Application of antimicrobial stewardship interventions improves outcomes in adults with bloodstream infection caused by multidrug-resistant Enterobacteriaceae.

Abstract

Background: The increasing incidence of multidrug-resistant Enterobacteriaceae (MDRE) presents a significant challenge in clinical settings. We aimed to evaluate the impact of antimicrobial stewardship interventions (ASIs) on clinical outcomes in patients with MDRE bloodstream infections (BSI).

Materials and methods: A single-center, pre-post quasi-experimental study was conducted on patients with BSIs caused by MDRE from March 1, 2014 to February 29, 2016. Infectious disease specialists actively reviewed all positive blood culture notifications and provided evidence-based recommendations for antibiotic therapy. The primary outcomes were 30-day mortality and time to appropriate antibiotics. Secondary outcomes included the hospital length of stay (LOS) after BSIs and duration of antibiotic therapy among survivors.

Results: Total 193 patients were included: 73 patients in the pre-intervention period and 120 patients in the intervention period. The 30-day mortality was lower in the intervention group (12.5% vs. 28.8%, P = 0.007). Species identification of BSI pathogens was more rapidly completed (median 70 h vs. 76 h, P = 0.001), and the time to appropriate antibiotics (median 9 h vs. 33 h, P < 0.001) and duration of antibiotic therapy (10 days vs. 12.5 days, P < 0.001) were shorter in the intervention group. Cox regression analysis revealed that ASIs were associated with a better prognosis among adults with MDRE BSIs (hazard ratio: 0.40; 95 % CI: 0.20-0.77; P = 0.006).

Conclusion: ASIs can reduce the time to appropriate antimicrobial therapy, shorten antibiotic therapy duration, and improve clinical outcomes in patients with BSIs caused by MDRE.