Impact of standard communication and antimicrobial stewardship on time to appropriate antimicrobial therapy in blood stream infections

In patients with a positive blood culture, does standard communication from the microbiology laboratory plus Antimicrobial Stewardship Team review improve the time to appropriate antimicrobial therapy when compared to standard laboratory communication methods?

Status

Completed

Phases

Phase 4

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12614000258651

Enrollment

160

Registered

2014-03-11

Start date

2014-02-27

Completion date

2015-12-29

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Bloodstream infections (BSI) are an important cause of morbidity and mortality. Several studies have demonstrated that early, appropriate antimicrobial therapy reduces BSI associated mortality and reduces hospital length of stay. Conversely, antimicrobial therapy should be minimised in patients that do not have infection to reduce the impact of antimicrobial agents on resistance, including in patients where blood culture isolates represent contamination. The aim of this project is to assess the implementation of Antimicrobial Stewardship Team review on time to appropriate antimicrobial therapy in patients with a positive blood culture at The Alfred Hospital.

Interventions

The intervention group will recieve both standard care (see comparator/control treatment) plus antimicrobial stewardship team review. Antimicrobial Stewardship Team review will occur on the same day (ie. within 12 hours) of the positive blood culture being announced at the weekday Microbiology Laboratory meeting. Antimicrobial Stewardship Team Review: This refers to a focused review of the patients medical record and relevant pathology/microbiology by an Infectious Diseases Physician, an Antimicrobial Stewardship Pharmacist and Infectious Diseases Registrar. The patient is not clinically reviewed during this process. Recommendations for antimicrobial therapy are dicussed with the treating unit and documented in the medical record. The clinical decision to alter antimicrobial therapy remains with the treating unit.

Study design

Allocation

Randomised controlled trial

Intervention model

Parallel

Primary purpose

Treatment

Masking

Blinded (masking used) (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

First episode positive blood culture detected by BacT/ALERT (Registered Trademark) 3D automated blood culture system

Exclusion criteria

Patients admitted under the Haematology, ID, Respiratory, Burns or Intensive Care Units where existing Infectious Diseases (ID) liaison services exist Patients who are currently receiving a formal ID consultation at the time of blood culture positivity Patients admitted at Sandringham or Caulfield Hospitals (as Antimicrobial Stewardship Team review does not currently operate routinely at these sites) Outpatients Patients in the emergency department/short stay unit who are discharged within 24 hours of blood culture positivity Patients transferred from a hospital outside of Alfred Health with a blood stream infection Patients transferred to another hospital within 24 hours of blood culture positivity Patients with antimicrobial agents already entered into Guidance MS Patients admitted under a medical unit where their treating physician is an ID physician Patients considered to be palliative and not for further medical intervention

Outcome results