Impact of an Antimicrobial Stewardship Bloodstream Surveillance Program (BSP) in Hospitalized Patients
Bibliographic record
Abstract
Bloodstream infections (BSI) in hospitalized patients represent sentinel events characterized by increased mortality. These infections represent an attractive stewardship opportunity because they warrant rapid initiation of empiric antimicrobial therapy, deft transition to directed (gram stain guided) and definitive (susceptibility guided) therapy. Under a retrospective pre-post study design, a review of patient charts 18 months before and 18 months after initiation of a hospital BSP was carried out. Pre-intervention, the hospital ward and attending physician were notified of all positive blood cultures (standard of care). Post-intervention an infectious disease pharmacist collaborating with an infectious disease consultant was notified in addition to standard notifications. 226 patients with BSI were identified pre-intervention and 195 patients post-intervention. The two cohorts were similar in baseline characteristics: the most common source of infection was urinary tract (Figure 1); the most common blood stream isolates were E. coli, S. aureus, β-hemolytic streptococci and K. pneumoniae (Figure 2); 71.7% of infections were community acquired; 11.4% were polymicrobial. Empiric therapy was given in 82.6% of patients (16.3% non-susceptible). Directed therapy was given in 54.9% of patients (3.5% non-susceptible). The post-intervention cohort received directed therapy on average 4.36 hours earlier (P = .003), were more likely to receive adequate definitive therapy (99.0% post vs. 79.1% pre, P < .001), and were stepped down to oral therapy earlier (6 days vs. 8 days). Prescription of second generation cephalosporins (0.0% vs. 4.3%, P = .05), quinolones (16.7% vs. 32.7%, P = .005), clindamycin (2.6% vs. 10.3%, P = .03) and aminoglycosides (6.1% vs. 14.6%, P = .05) were decreased for directed therapy post-intervention. A hospital BSP can improve time to first dose of parenteral antimicrobial directed therapy and adequacy of definitive therapy, shorten time from IV to oral step-down and reduce prescription of targeted antimicrobial classes. A BSP can be an effective stewardship strategy in hospitalized patients. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".