Restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection

Ritchie, N. D., Irvine, S. C., Helps, A., Robb, F., Jones, B. L. and Seaton, R. A. (2017) Restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection. QJM: An International Journal of Medicine, 110(3), pp. 155-161. (doi: 10.1093/qjmed/hcw134) (PMID:27521583)

Abstract

Introduction: Antimicrobial stewardship has an important role in the control of Clostridium difficile infection (CDI) and antibiotic resistance. An important component of UK stewardship interventions is the restriction of broad-spectrum beta-lactam antibiotics and promotion of agents associated with a lower risk of CDI such as gentamicin. Whilst the introduction of restrictive antibiotic guidance has been associated with improvements in CDI and antimicrobial resistance evidence of the effect on outcome following severe infection is lacking. Methods: In 2008, Glasgow hospitals introduced a restrictive antibiotic guideline. A retrospective before/after study assessed outcome following gram-negative bacteraemia in the 2-year period around implementation. Results: Introduction of restrictive antibiotic guidelines was associated with a reduction in utilisation of ceftriaxone and co-amoxiclav and an increase in amoxicillin and gentamicin. 1593 episodes of bacteraemia were included in the study. The mortality over 1 year following gram-negative bacteraemia was lower in the period following guideline implementation (RR 0.852, P = 0.045). There was no evidence of a difference in secondary outcomes including ITU admission, length of stay, readmission, recurrence of bacteraemia and need for renal replacement therapy. There was a fall in CDI (RR 0.571, P = 0.014) and a reduction in bacterial resistance to ceftriaxone and co-amoxiclav but no evidence of an increase in gentamicin resistance after guideline implementation. Conclusion: Restrictive antibiotic guidelines were associated with a reduction in CDI and bacterial resistance but no evidence of adverse outcomes following gram-negative bacteraemia. There was a small reduction in one year mortality.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Seaton, Dr Andrew and Ritchie, Dr Neil and Jones, Dr Brian and Irvine, Dr Sharon
• Authors: Ritchie, N. D., Irvine, S. C., Helps, A., Robb, F., Jones, B. L., and Seaton, R. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: QJM: An International Journal of Medicine
• Publisher: Oxford University Press
• ISSN: 1460-2725
• ISSN (Online): 1460-2393
• Published Online: 12 August 2016
• Copyright Holders: Copyright © 2016 The Authors
• First Published: First published in QJM: An International Journal of Medicine 110(3): 155-161
• Publisher Policy: Reproduced in accordance with the publisher copyright policy