The Impact of Incorporating Infectious Diseases Led Antimicrobial Stewardship into Multidisciplinary Rounds in the Intensive Care Unit

Background: The availability of infectious diseases (ID) expertise at the point of care has the potential to impact antimicrobial stewardship (AS). Multidisciplinary AS-focused rounds serve to improve knowledge of AS principles among front-line staff, make patient-focused interventions, and promote a collaborative, team approach to patient care. This study evaluated the impact of AS rounds on antibiotic utilization and C. difficile in the intensive care unit (ICU) setting.

Methods: Two medical/surgical critical care units of a 488–bed community hospital were targeted for AS rounds. AS rounds were led by ID physicians, who rotated rounding duties among three members of a private practice group, assisted by an ID-trained pharmacist, and accompanied by the ICU team. AS rounds occurred two times a week, included chart review of all patients on antimicrobials, group discussion, and verbal feedback of AS recommendations to ICU providers. Staggered implementation occurred at two time points: December 2014 in ICU A and March 2015 in ICU B. The study period of January 2014 to February 2016 included a minimum 11-month pre- and 12-month post-period for both units. The effect of ICU rounds on antibiotic use (AU) in days of therapy per 1,000 patient days and rate of hospital-onset LabID C. difficile events were evaluated by time-segmented Poisson regression adjusted for clustering by unit and first-order autocorrelation.

Results: Monthly recommendation acceptance rates from AS rounds ranged from 73% to 94%. Reduction in AU was observed among all antibiotics from the pre- to post-period 1499 vs. 1280 DOT/1,000 patient days (Adjusted Rate Ratio 0.84, 95% Confidence Interval 0.70-1.00, p=0.05). Reductions were observed in both anti-pseudomonal beta-lactam antibiotics (0.88, 0.77-1.00, p=0.06), and anti-MRSA antibiotics (0.70, 0.62-0.81, p<.001). C. difficile rates significantly decreased during the post-intervention period (0.14, 0.06-0.37, p<.001). Slope in the post-intervention period was numerically positive for AU outcomes, indicating a need to maintain enthusiasm over time.

Conclusion: Leadership by ID experts during multidisciplinary, AS-focused rounds in the ICU reduced antibiotic exposures and C. difficile rates in a large community hospital.