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Impact of Two Different Antimicrobial Stewardship Methods on Frequency of Streamlining Antimicrobial Agents in Patients with Bacteremia

  • Jennifer Lukaszewicz Bushen (a1), Jimish M. Mehta (a2), Keith W. Hamilton (a3), Shawn Binkley (a1), Daniel R. Timko (a1), Ebbing Lautenbach (a3) and David A. Pegues (a3)...



To assess the likelihood of antimicrobial streamlining between 2 antimicrobial stewardship methods.


Retrospective cohort study.


Large academic medical center.


Frequency and time to antimicrobial streamlining were compared during a prior authorization and a prospective audit period. Streamlining was defined as an antimicrobial change to a narrower agent if available or to a broader agent if the isolate was resistant to empiric therapy. Patients included were ≥18 years old with monomicrobial bacteremia with S. aureus, Enterococcus spp., or any aerobic Gram-negative organism.


A total of 665 cases of bacteremia met inclusion criteria. Frequency of streamlining was similar between periods for all cases of bacteremia (audit vs restriction: 60.7% vs 53.2%; P=.12), S. aureus bacteremia (73.2% vs 76.9%; P=.671), and Enterococcus bacteremia (81.6% vs 71.9%; P=.335). Compared to restriction, the audit period was associated with an increased frequency of streamlining for cases of Gram-negative bacteremia (51.4% vs 35.6%; odds ratio [OR], 1.85; 95% confidence interval [CI], 1.06–3.25), those on the medical service (67.9% vs 53.1%; OR, 1.86; 95% CI, 1.09–3.16), and those admitted through the emergency department (71.6% vs 51.4%; OR, 2.32; 95% CI, 1.24–4.34). Characteristics associated with increased streamlining included: absence of β-lactam allergy (P<.001), Gram-negative bacteremia (P<.001), admission through the emergency department (P=.001), and admission to a medical service (P=.011).


Compared with prior authorization, prospective audit increased antimicrobial streamlining for cases of Gram-negative bacteremia, those admitted through the emergency department, and those admitted to a medical but not surgical service.

Infect Control Hosp Epidemiol 2016:1–7


Corresponding author

Address correspondence to Jennifer Lukaszewicz Bushen, 3400 Spruce Street, Philadelphia, PA19104, 856-904-0979 (


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PREVIOUS PRESENTATION. The data included in this article were presented at IDWeek 2013 in San Francisco, California, on October 2, 2013.



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