Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital

Table 1 Demographic, clinical and outcome data of 143 patients with differing therapy-modifying recommendations by ASP and ID physicians

	ASP recommendation accepted	ID physician recommendation accepted	p-value
	(n= 100)	(n= 43)	p-value
Median age, years (interquartile range)	64 (53–72)	58 (50 – 72)	0.393
Intensive care unit admission within 30 days prior to review (%)	23 (23.0)	10 (23.3)	0.973
Median Charlson Comorbidity Index (interquartile range)	5 (3 – 8)	5 (2 – 8)	0.255
Clinical discipline (%)			0.754
• Hematology-oncology	36 (36.0)	12 (27.9)
• Surgery	29 (29.0)	12 (27.9)
• Orthopedics	24 (24.0)	13 (30.2)
• Medicine	10 (10.0)	6 (14.0)
• Others	1 (1.0)	0 (0)
Type of infection (%):			0.247
• Intra-abdominal infection	23 (23.0)	9 (20.9)
• Bloodstream	12 (12.0)	6 (14.0)
• Bone and joint infection	14 (14.0)	12 (27.9)
• Skin and soft tissue infection	15 (15.0)	6 (14.0)
• Respiratory tract infection	6 (6.0)	2 (4.7)
• Urinary tract infection	10 (10.0)	6 (14.0)
• Others^a	20 (20.0)	2 (4.7)
Type of ASP recommendations:^b			0.172
• Discontinue antibiotics	26	5
• De-escalate antibiotics	30	16
• Escalate antibiotics	8	5
• Intravenous to oral antibiotic switch	6	2
• Dose optimization	16	5
• Duration of antibiotics	0	2
• Discontinue duplicate antibiotic coverage	9	7
• Other recommendations^c	10	3
Outcomes (%):
• 30-day mortality	7 (7.0)	3 (7.0)	1.000
• 30-day re-admission^d	21 (22.6)	6 (15.0)	0.358
• Clinical deterioration	8 (8.0)^e	12 (27.9)^f	0.003
○ Persistent fever	2 (25.0)	4 (33.3)
○ No microbiological clearance	2 (25.0)	3 (25.0)
○ Lack of physiological improvement	6 (75.0)	10 (83.3)

^a"Others" include undifferentiated fevers, viral infections, and no infection.
^bThere were 150 ASP recommendations for 143 patients.
^c"Other recommendations" include switching to less expensive carbapenems (9 cases), streamlining antibiotics (2 cases) and addition of antifungal agents (2 cases).
^dPatients who had died are excluded.
^eOne patient had persistent fever and bacteremia; one patient had persistent fever with hypotensive episodes; one patient had persistent candidemia with respiratory distress.
^fTwo patients had persistent fever and persistent positive wound cultures; one patient had persistent fever and bacteremia with cardiac failure; one patient had persistent fever with hypotension.

ISSN: 2047-2994