Infection and Drug Resistance (Jan 2024)

Multiple Blood Culture Sampling, Proper Antimicrobial Choice, and Adequate Dose in Definitive Therapy Supported by the Antimicrobial Stewardship Team Could Decrease 30-Day Sepsis Mortality Rates

  • Saito N,
  • Tsuchiya J,
  • Itoga M,
  • Okamura Y,
  • Tsuyama H,
  • Kimura M,
  • Inoue F,
  • Kimura T,
  • Ozaki H,
  • Tono Y,
  • Minakawa S,
  • Tomita H

Journal volume & issue
Vol. Volume 17
pp. 207 – 219

Abstract

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Norihiro Saito,1– 3 Junichiro Tsuchiya,1,3 Masamichi Itoga,1,2 Yuji Okamura,1,4 Hiromasa Tsuyama,1,4 Masahiko Kimura,1,3 Fumio Inoue,1,3 Toshiyuki Kimura,1 Hiromi Ozaki,1 Yuka Tono,1,4 Satoko Minakawa,1,3 Hirofumi Tomita2,3,5 1Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, Aomori, Japan; 2Department of Clinical Laboratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan; 3Division of Clinical Laboratory, Hirosaki University Hospital, Hirosaki, Aomori, Japan; 4Division of Pharmacy, Hirosaki University Hospital, Hirosaki, Aomori, Japan; 5Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, JapanCorrespondence: Norihiro Saito, Division of Infection Control and Prevention, Hirosaki University Hospital, 53 Hon-cho, Hirosaki, Aomori, 036-8563, Japan, Tel +81-172-33-5111, Email [email protected]: This study aimed to identify factors that should be focused on by the antimicrobial stewardship team for treating patients with sepsis, by investigating the mortality of patients with sepsis within 30 days and the mortality-related factors in our hospital over a 10-year period from the perspective of appropriate antimicrobial use.Methods: Factors associated with 30-day mortality were investigated using hierarchical multiple logistic regression in 1406 patients with pathogen-identified sepsis in Hirosaki University Hospital. These factors were clinical data, microbiological data, antimicrobials used in empiric and definitive therapies, presence/absence of ineffective use, underdosing as evaluated using Monte Carlo simulation, and practice of de-escalation.Results: The ineffective use of antimicrobials in empiric therapy and the underdosing and ineffective use in definitive therapy were significantly associated with 30-day mortality (odds ratio [OR] = 2.70, 3.72, and 3.65, respectively). Multiple blood culture sampling was inversely associated with these inappropriate antimicrobial uses. Every year, the 30-day mortality rate has been decreasing, in line with the increase in multiple blood culture sampling and de-escalation; the inappropriate use of antimicrobials has also decreased.Conclusion: Multiple blood culture sampling, proper choice of antimicrobial, and using an adequate dose in definitive therapy could decrease the 30-day mortality rate in patients with sepsis and these factors could be supported by the antimicrobial stewardship team.Keywords: sepsis, antimicrobial stewardship, Monte Carlo simulation, de-escalation

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