Authors (including presenting author) :
Li CM (1), Mung MK (1), Cheung SK (1), Au-Yeung CT (1), Ho HY (1), Luk WLF (1), Leung CM (2), Lai KCC (2), Chow CYV (2) Lui CYG (1)
Affiliation :
(1) Department of Medicine & Therapeutics, (2) Department of Microbiology, Prince of Wales Hospital
Keyword 1: :
Antibiotic stewardship
Keyword 2: :
Bloodstream infections
Introduction :
Despite the availability of ample evidence supporting short-course (7 days) and oral-switch antibiotic therapy for bloodstream infection due to Enterobacterales (BSI-E), most physicians prescribe prolonged courses of intravenous antibiotics.
Objectives :
To compare the effectiveness of physician education, reminders, and a multifaceted antibiotic stewardship intervention in impacting physicians’ (1) prescription of short-course antibiotic and (2) de-escalation to oral antibiotic therapy for BSI-E
Methodology :
A pragmatic cluster-randomized controlled trial was conducted. Adult patients hospitalized in medical wards of Prince of Wales Hospital with BSI-E were included and randomized into 3 groups: (1) physician education alone; (2) education plus paper reminder; (3) education plus multifaceted antibiotic stewardship intervention. Exclusion criteria were infections requiring prolonged treatment, nosocomial infection or death before day 7 of effective antibiotic treatment, inadequate source control, and neutropenia or recent stem cell transplant. The primary outcome was the proportion of patients receiving 7 days of effective antibiotic therapy. Secondary outcomes were proportion of patients with oral switch, 30-day mortality, length of stay and re-admission within 90 days. Intention-to-treat (all randomized patients) and modified intention-to-treat analyses (excluding patients who met exclusion criteria after randomization) were performed.
Result & Outcome :
We recruited 472 patients (group 1: 144, group 2: 162, group 3: 166); 204 (43.2%) were men, and the median age was 79.5 years. The most common infections were urinary (316, 66.9%), and the most common pathogens were Escherichia coli (358, 75.8%). The proportions of patients who received 7 days of effective antibiotics were 40 (27.8%), 55 (34.0%) and 116 (69.9%) in groups 1, 2 and 3 respectively (p< 0.001). Among the 342 patients with susceptible oral antibiotics, 48 (49.5%), 64 (51.2%), and 78 (65.0%) in groups 1, 2 and 3 respectively were switched to oral antibiotics (p=0.034). Thirty patients (6.4%) died within 30 days. Other secondary outcomes were similar across the three groups. Conclusions:
Antibiotics stewardship team intervention significantly improved short-course oral-switch antibiotic therapy for BSI-E, compared with physician education and paper reminders.
