Prospective antimicrobial audit and feedback did not decrease case fatality: Experiences from a hospital in northern Taiwan

  • Chien-Yu Cheng Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
  • Chien-Yu Lee Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
  • Min-Wen Wu Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
  • Chen-Hung Chang Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
  • Wan-Ying Huang Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
  • Yi-Fen Chuang Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
  • Pei-Hsin Tang Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
  • Shu-Hsing Cheng Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Keywords: prospective antimicrobial audit and feedback, antibiotic stewardship, fatality

Abstract

Introduction: Although a prospective antimicrobial audit and feedback is an effective strategy in an antibiotic stewardship program, previous researchers have not adequately demonstrated a successful impact on patient outcomes. In this study, the causes of fatalities associated with a prospective antimicrobial audit and feedback were analyzed.

Methodology: Between June and September 2014, applications for 16 target parenteral formulas (including ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, vancomycin, teicoplanin, ertapenem, imipenem/cilastatin, meropenem, levofloxacin, moxifloxacin, ciprofloxacin, tigecycline, linezolid, daptomycin, and amikacin), which were not approved by infectious diseases (ID) specialists, were followed up until patients were either discharged or passed away.

Results: Of the 292 cases studied, 193 (66%) were male, with a mean age (standard deviation) of 65.5 (19.3) years. There were five reasons for rejection, including dosage adjustments (37%), no evidence of bacterial infection (28.8%), modifications according to antimicrobial susceptibility (18.8%), target pathogens not being covered (7.2%), and redundant therapy (4.1%). Multiple logistic regression analysis demonstrated that an age greater than 75 years (odds ratio [OR]: 2.58; 95% confidence interval [CI]: 1.32–5.50; p = 0.005) was associated with significant mortality, while urinary tract (OR: 0.26; 95% CI: 0.09–0.70; p = 0.013) and soft tissue/bone infections (OR: 0.18; 95% CI: 0.05–0.61; p = 0.006) were associated with survival. Adjustments according to ID physicians’ recommendations were not statistically significant (OR: 0.53; 95% CI: 0.27–1.06; p = 0.074).

Conclusions: Antimicrobial adjustments according to ID physicians’ recommendations showed only marginally preventative effects against fatalities.

Author Biographies

Chien-Yu Cheng, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Attending physician, department of infectious diseases
Chien-Yu Lee, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Director, neonatal intensive care unit, department of pediatrics
Min-Wen Wu, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Deputy director, department of pharmacy
Chen-Hung Chang, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Director, department of pharmacy
Wan-Ying Huang, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Infection Control Nurse, Infection Control Committee
Yi-Fen Chuang, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Infection Control Nurse, Infection Control Committee
Pei-Hsin Tang, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
Infection Control Nurse, Infection Control Committee
Shu-Hsing Cheng, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan

Director, department of infectious diseases;

Associate professor, school of public health

Published
2016-04-28
How to Cite
1.
Cheng C-Y, Lee C-Y, Wu M-W, Chang C-H, Huang W-Y, Chuang Y-F, Tang P-H, Cheng S-H (2016) Prospective antimicrobial audit and feedback did not decrease case fatality: Experiences from a hospital in northern Taiwan. J Infect Dev Ctries 10:395-399. doi: 10.3855/jidc.6891
Section
Brief Original Articles