Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia.
Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia; Department of Medicine, Centre for Inflammatory Diseases, Monash University, Clayton, Victoria, Australia.
Int J Antimicrob Agents. 2021 Apr;57(4):106301. doi: 10.1016/j.ijantimicag.2021.106301. Epub 2021 Feb 12.
Escherichia coli is the most commonly identified bacteraemia, and causes a broad spectrum of diseases. The range of clinical conditions associated with E. coli bacteraemia mean that antimicrobial therapy is highly variable. This study aimed to determine the workload, efficiency and potential impact of an antimicrobial stewardship (AMS) bundle approach to E. coli bacteraemia.
An observational cohort study of patients with E. coli bacteraemia was performed, and a review of each case's entire medical record was undertaken. A number of AMS interventions were modelled on this cohort to assess their impact on overall days of antimicrobial therapy and time to optimized antimicrobial therapy.
In total, 566 episodes of E. coli bacteraemia were identified. A number of AMS interventions were modelled to assess their impact. The strict implementation of guideline-based therapy was found to increase the number of patients receiving ineffective empirical therapy to 38/266 (14.3%) compared with 27/266 (10.2%) patients when w hen non-guideline-adherent therapy was allowed. A scheduled review by an AMS team on day 3 of empirical therapy could lead to a narrower-spectrum intravenous antibiotic in 237/515 (46%) cases, and 386 cases (68.2% of cohort) could have their duration of therapy reduced by a median of 7 days.
This study provides detailed description of a large cohort of patients with E. coli bacteraemia. There remains significant variability in empirical treatment, choice of step-down therapy and antimicrobial duration. A significant opportunity exists for AMS programmes to impact the management of E. coli bacteraemia through a bundled approach.
大肠杆菌是最常见的菌血症病原体，可引起广泛的疾病。与大肠杆菌菌血症相关的临床病症范围广泛，这意味着抗菌治疗的选择具有很大的变异性。本研究旨在确定抗菌药物管理（AMS）方案对大肠杆菌菌血症的工作量、效率和潜在影响。
对大肠杆菌菌血症患者进行了一项观察性队列研究，并对每个病例的整个病历进行了回顾。对该队列中的多种 AMS 干预措施进行建模，以评估其对总抗菌治疗天数和优化抗菌治疗时间的影响。
共确定了 566 例大肠杆菌菌血症病例。对多种 AMS 干预措施进行建模以评估其影响。与允许非指南依从性治疗时相比，严格实施基于指南的治疗会导致接受无效经验性治疗的患者数量增加到 38/266（14.3%），而非 27/266（10.2%）。在经验性治疗的第 3 天由 AMS 团队进行计划审查，可能导致 237/515（46%）的病例使用更窄谱的静脉内抗生素，并且 386 例（队列的 68.2%）的治疗时间中位数可缩短 7 天。
本研究详细描述了一大群大肠杆菌菌血症患者。在经验性治疗、降级治疗选择和抗菌治疗持续时间方面仍存在很大的变异性。AMS 计划通过捆绑方案对大肠杆菌菌血症的管理产生影响的机会很大。
