Table 1.
Baseline demographics, AMS round details and antimicrobial prescribing for studied cohorts
| Pre-implementation | Immediately post-implementation | 3 years post-implementation | P valuea | P valueb | |
|---|---|---|---|---|---|
| Stewardship round | |||||
| Number of rounds | 27 (potential) | 27 | 27 | ||
| Number of all patients on ward per round, median (IQR) | 25 (25–27) | 23 (21–26) | 26 (23–27) | ||
| Number of SCI patients on ward per round, median (IQR) | 20 (19–21) | 18 (15–20) | 19 (15–21) | 0.52 | 0.24 |
| Number of SCI patients prescribed antimicrobials on ward per round, median (IQR) | 8 (7–9) | 6 (5–8) | 4 (3–6) | 0.86 | <0.001 |
| Antimicrobial orders reviewed, n | 148 | 141 | 108 | 0.66 | 0.05 |
| Antimicrobial courses reviewed, n | 104 | 103 | 82 | 0.51 | 0.25 |
| Average AMS moments per round, n | NA | 5 | 5 | NA | NA |
| AMS acceptance rate, % | NA | 92 | 95 | NA | NA |
| Patient demographics (patients included in review) | |||||
| N | 68 | 66 | 51 | ||
| LOS, days, median (IQR) | 15 (7–49) | 25 (9–65) | 20 (9–49) | 0.14 | 0.50 |
| Male, n (%) | 50 (74) | 50 (76) | 43 (84) | 0.84 | 0.18 |
| Age, years, median (IQR) | 55 (44–67) | 54 (39–64) | 59 (38–71) | 0.36 | 0.59 |
| CCI, median (IQR) | 2 (0–4) | 2 (0–4) | 2 (1–4) | 0.74 | 0.95 |
| 90 day mortality, n (%) | 2 (3) | 3 (5) | 3 (6) | 0.67 | 0.65 |
| Antimicrobial (Abx) order duration, days, median (IQR) | |||||
| N | 148 | 141 | 108 | ||
| Total Abx duration | 7 (5–11) | 6 (4–11) | 5 (3–7) | <0.001 | <0.001 |
| IV Abx duration | 7 (4–8) | 6 (4–14) | 3 (2–7) | 0.78 | <0.001 |
| PO Abx duration | 8 (6–14) | 6 (4–10) | 6 (4–10) | <0.001 | 0.003 |
| Topical antimicrobial duration | 20 (8–31) | 14 (4–26) | 42 (13–42) | 0.35 | 0.53 |
| Antimicrobial course duration by indication, days, median (IQR) | |||||
| Overall course duration | 11 (8–19) (n = 104) | 10 (6–15) (n = 103) | 7 (5–11) (n = 82) | 0.001 | <0.001 |
| Skin/soft tissue infection | 12 (7–14) (n = 17) | 13 (10–15) (n= 16) | 5 (4–12) (n = 7) | 0.62 | 0.045 |
| Bacteraemia | 15 (14–15) (n = 5) | 14 (12–14) (n = 6) | 21 (12–30) (n = 4) | 0.16 | 0.64 |
| Pulmonary infection | 10 (7–12) (n= 23) | 6 (5–7) (n = 17) | 5 (5–8) (n = 11) | 0.001 | 0.022 |
| Osteomyelitis/septic arthritis | 42 (15–72) (n= 8) | 46 (41–50) (n = 10) | 42 (38–46) (n = 3) | 0.78 | 0.97 |
| Gastrointestinal infection | 12 (9–17) (n = 4) | 11 (10–20) (n = 6) | 10 (10–13) (n = 8) | 0.72 | 0.85 |
| Urogenital infection | 9 (6–12) (n= 30) | 7 (5–10) (n= 27) | 7 (5–8) (n = 39) | 0.073 | 0.009 |
| Prophylactic antimicrobials | 10 (9–10) (n = 2) | 3 (1–5) (n = 4) | 3 (3–4) (n = 2) | 0.042 | 0.010 |
| Superficial fungal infection | 20 (24–52) (n = 12) | 15 (12–24) (n = 14) | 30 (19–41) (n = 6) | 0.019 | 0.49 |
| Other (deep source) | 19 (13–20) (n = 3) | 40 (38–54) (n = 3) | 15 (1–23) (n = 2) | 0.033 | 0.59 |
AMS, antimicrobial stewardship; CCI, Charlson Comorbidity Index; LOS, length of stay; NA, not applicable; PO, per os (orally); SCI, spinal cord injury.
aImmediately post- versus pre-implementation.
bThree years versus pre-implementation; non-parametric tests.