Impact of timing in prospective audit and feedback on broad-spectrum antibiotic use: a comparison between third-day and seventh-day interventions

IF 1.7 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2026-01-01 Epub Date: 2025-12-15 DOI:10.1016/j.jiac.2025.102896

Hisako Machida , Yoshiki Kusama , Daisuke Onozuka , Atsuko Sunada , Satoshi Kutsuna

{"title":"Impact of timing in prospective audit and feedback on broad-spectrum antibiotic use: a comparison between third-day and seventh-day interventions","authors":"Hisako Machida , Yoshiki Kusama , Daisuke Onozuka , Atsuko Sunada , Satoshi Kutsuna","doi":"10.1016/j.jiac.2025.102896","DOIUrl":null,"url":null,"abstract":"<div><div>Prospective audit and feedback (PAF) is a key component of antimicrobial stewardship (AS) programs and has been shown to reduce the use of broad-spectrum antibiotics. However, the optimal timing of PAF intervention remains unclear.</div><div>This quasi-experimental, single-center study investigated the impact of changing PAF timing from day 3 to day 7 after initiating empirical broad-spectrum antibiotics. Monthly days of therapy (DOT) for carbapenems (CAR), piperacillin-tazobactam (PIP/TAZ), and cefepime (PEF) were extracted from 2016 to 2024. Annual susceptibility rates of <em>Pseudomonas aeruginosa</em> and the time from blood culture submission to susceptibility results were also evaluated. Interrupted time series analysis assessed changes in DOT, while other data were descriptively analyzed.</div><div>DOT for CAR and PIP/TAZ decreased significantly post-intervention (CAR: −0.68, P < 0.001; PIP/TAZ: −0.29, P = 0.031), despite no significant change in trend slopes. PEF showed no significant changes. Susceptibility rates of <em>P. aeruginosa</em> remained stable. Notably, 28.3 % of blood culture results exceeded 4 days to report, and 95 % were available by day 7.</div><div>As causality cannot be inferred from this observational design, the mechanism underlying the observed reduction in DOT remains uncertain. Nevertheless, adjusting PAF timing may be feasible in settings with limited stewardship resources. Further studies are needed to determine the most effective timing of PAF interventions and to assess generalizability to other institutions.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"32 1","pages":"Article 102896"},"PeriodicalIF":1.7000,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1341321X25002946","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/12/15 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Prospective audit and feedback (PAF) is a key component of antimicrobial stewardship (AS) programs and has been shown to reduce the use of broad-spectrum antibiotics. However, the optimal timing of PAF intervention remains unclear.

This quasi-experimental, single-center study investigated the impact of changing PAF timing from day 3 to day 7 after initiating empirical broad-spectrum antibiotics. Monthly days of therapy (DOT) for carbapenems (CAR), piperacillin-tazobactam (PIP/TAZ), and cefepime (PEF) were extracted from 2016 to 2024. Annual susceptibility rates of Pseudomonas aeruginosa and the time from blood culture submission to susceptibility results were also evaluated. Interrupted time series analysis assessed changes in DOT, while other data were descriptively analyzed.

DOT for CAR and PIP/TAZ decreased significantly post-intervention (CAR: −0.68, P < 0.001; PIP/TAZ: −0.29, P = 0.031), despite no significant change in trend slopes. PEF showed no significant changes. Susceptibility rates of P. aeruginosa remained stable. Notably, 28.3 % of blood culture results exceeded 4 days to report, and 95 % were available by day 7.

As causality cannot be inferred from this observational design, the mechanism underlying the observed reduction in DOT remains uncertain. Nevertheless, adjusting PAF timing may be feasible in settings with limited stewardship resources. Further studies are needed to determine the most effective timing of PAF interventions and to assess generalizability to other institutions.

查看原文本刊更多论文

前瞻性审核和反馈时间对广谱抗生素使用的影响：第三天和第七天干预措施的比较

前瞻性审核和反馈（PAF）是抗菌药物管理（AS）计划的关键组成部分，已被证明可以减少广谱抗生素的使用。然而，PAF干预的最佳时机仍不清楚。这项准实验、单中心研究调查了在使用经验性广谱抗生素后第3天至第7天改变PAF时间的影响。提取2016 - 2024年碳青霉烯类药物（CAR）、哌拉西林-他唑巴坦（PIP/TAZ）和头孢吡肟（CEF）的月治疗天数（DOT）。同时对铜绿假单胞菌的年敏感性和血培养提交至药敏结果的时间进行了评价。中断时间序列分析评估DOT的变化，而其他数据进行描述性分析。干预后，尽管趋势斜率没有显著变化，但CAR和PIP/TAZ的DOT显著下降（CAR: -0.68, P < 0.001; PIP/TAZ: -0.29, P = 0.031）。CEF无明显变化。铜绿假单胞菌的敏感率保持稳定。值得注意的是，28.3%的血培养结果超过4天报告，95%的血培养结果在第7天报告。由于因果关系不能从这种观察设计中推断出来，因此观察到的DOT减少的机制仍然不确定。然而，在管理资源有限的情况下，调整PAF时间可能是可行的。需要进一步的研究来确定PAF干预的最有效时机，并评估对其他机构的推广。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.