Table 1.
Demographic, clinical and outcome data of 143 patients with differing therapy-modifying recommendations by ASP and ID physicians
|
ASP recommendation accepted |
ID physician recommendation accepted |
p -value | |
|---|---|---|---|
| ( n = 100) | ( n = 43) | ||
| Median age, years (interquartile range) |
64 (53–72) |
58 (50 – 72) |
0.393 |
| Intensive care unit admission within 30 days prior to review (%) |
23 (23.0) |
10 (23.3) |
0.973 |
| Median Charlson Comorbidity Index (interquartile range) |
5 (3 – 8) |
5 (2 – 8) |
0.255 |
| Clinical discipline (%) |
|
|
0.754 |
| • Hematology-oncology |
36 (36.0) |
12 (27.9) |
|
| • Surgery |
29 (29.0) |
12 (27.9) |
|
| • Orthopedics |
24 (24.0) |
13 (30.2) |
|
| • Medicine |
10 (10.0) |
6 (14.0) |
|
| • Others |
1 (1.0) |
0 (0) |
|
| Type of infection (%): |
|
|
0.247 |
| • Intra-abdominal infection |
23 (23.0) |
9 (20.9) |
|
| • Bloodstream |
12 (12.0) |
6 (14.0) |
|
| • Bone and joint infection |
14 (14.0) |
12 (27.9) |
|
| • Skin and soft tissue infection |
15 (15.0) |
6 (14.0) |
|
| • Respiratory tract infection |
6 (6.0) |
2 (4.7) |
|
| • Urinary tract infection |
10 (10.0) |
6 (14.0) |
|
| • Othersa |
20 (20.0) |
2 (4.7) |
|
| Type of ASP recommendations:b |
|
|
0.172 |
| • Discontinue antibiotics |
26 |
5 |
|
| • De-escalate antibiotics |
30 |
16 |
|
| • Escalate antibiotics |
8 |
5 |
|
| • Intravenous to oral antibiotic switch |
6 |
2 |
|
| • Dose optimization |
16 |
5 |
|
| • Duration of antibiotics |
0 |
2 |
|
| • Discontinue duplicate antibiotic coverage |
9 |
7 |
|
| • Other recommendationsc |
10 |
3 |
|
| Outcomes (%): |
|
|
|
| • 30-day mortality |
7 (7.0) |
3 (7.0) |
1.000 |
| • 30-day re-admissiond |
21 (22.6) |
6 (15.0) |
0.358 |
| • Clinical deterioration |
8 (8.0)e |
12 (27.9)f |
0.003 |
| ○ Persistent fever |
2 (25.0) |
4 (33.3) |
|
| ○ No microbiological clearance |
2 (25.0) |
3 (25.0) |
|
| ○ Lack of physiological improvement | 6 (75.0) | 10 (83.3) |
a"Others" include undifferentiated fevers, viral infections, and no infection.
bThere were 150 ASP recommendations for 143 patients.
c"Other recommendations" include switching to less expensive carbapenems (9 cases), streamlining antibiotics (2 cases) and addition of antifungal agents (2 cases).
dPatients who had died are excluded.
eOne patient had persistent fever and bacteremia; one patient had persistent fever with hypotensive episodes; one patient had persistent candidemia with respiratory distress.
fTwo patients had persistent fever and persistent positive wound cultures; one patient had persistent fever and bacteremia with cardiac failure; one patient had persistent fever with hypotension.