What is it about?
Antimicrobial Stewards have always wondered if it is possible to optimize empirical antimicrobial therapy without increasing the use of broad-spectrum agents. In this quasi-experimental study, a bundle of institutional management guidelines, antimicrobial stewardship prospective monitoring and rapid diagnostics improved empirical antimicrobial therapy to as high as 97% in critically-ill patients with gram-negative bloodstream infections. This was achieved while using less combination therapy and broad-spectrum agents.
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Why is it important?
The study provides a proof of concept that optimizing patient care, which is the ultimate goal of antimicrobial stewardship, does not automatically imply excessive use of antibiotics. To the contrary, a systematic approach with heavy stewardship involvement resulted in reduction in the utilization of broad-spectrum antimicrobial agents. The addition of multiplex PCR panel for rapid identification of bloodstream isolates combined with antimicrobial stewardship team's clinical tools for prediction of antimicrobial resistance allowed timely de-escalation of broad-spectrum agents within 2.2 days.
Perspectives
Rapid diagnostic testing is taking our specialty to new horizons. Since time to de-escalation off broad-spectrum therapy has been 4 days using conventional microbiological testing, it is not surprising that an objective evidence for the benefit of de-escalation of therapy is hard to find in the existing literature. Four days of broad-spectrum therapy is long enough to plant the seeds for antimicrobial resistance, Clostridium difficile infection and other adverse events. As rapid diagnostics and progressive antimicrobial stewardship combine to make early de-escalation of therapy within just over 2 days a reality, the benefits of early de-escalation will definitely be seen in clinical studies in the near future.
Prof. Majdi Al-Hasan
University of South Carolina School of Medicine
Read the Original
This page is a summary of: Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections, Antimicrobial Agents and Chemotherapy, June 2017, ASM Journals,
DOI: 10.1128/aac.00189-17.
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