The impact of an antimicrobial stewardship team on the appropriateness of antimicrobial therapy in sepsis

In hospital patients with medical emergency team (MET) calls for suspected sepsis, antimicrobial therapy is currently managed by the admitting, or home, team. Complex cases may be referred to specialist Infectious Diseases (ID) clinicians on request by the treating team. The antimicrobial stewardship (AMS) team (ID physician and pharmacist) currently conduct a post prescription review of a limited patient group, after the prescription of restricted antimicrobial agents or a positive blood culture result. The former group is primarily identified by clinical pharmacists who request review of their patients, but the AMS team also reviews patients on broad spectrum antimicrobial agents identified by other means. This AMS review is a focused review of medical records, pathology results and clinical notes, but does not include a clinical or physical review of the patient. The AMS team then make recommendations about antimicrobial therapy to the treating team. Currently, patients with MET calls for suspected sepsis are not routinely seen by the AMS team, despite the use of broad-spectrum antimicrobial agents. Many of these patients are not flagged to the AMS team via the current practice, or referral via current notification mechanisms is often delayed. The intervention will be ongoing standard care as above, as well as an expert ID AMS review at 48 hours after a MET call for suspected sepsis.