Timing of antimicrobial stewardship intervention and mortality among patients admitted to intensive care unit

OBJECTIVES: Antimicrobial stewardship is important in the intensive care unit (ICU), where critically ill patients are managed. Herein, we aimed to evaluate the associations between the timing of antimicrobial stewardship team (AST) interventions in the ICU and patient mortality and to identify the optimal timing of interventions to improve patient survival. MATERIALS AND METHODS: We retrospectively analyzed the data of patients admitted to the ICU at Showa Medical University Northern Yokohama Hospital (April 2016 - March 2023). The primary outcome was in-hospital mortality; the key exposure was the timing of AST intervention following antimicrobial initiation. Mortality incidence rates per 100 person-days and age-adjusted incidence rate ratios were calculated. RESULTS: Overall, 94 patients were included. Earlier AST intervention after ICU admission was associated with the lowest mortality (incidence rate (IR): 0.205 (95% confidence interval (CI): 0 - 0.512) per 100 person-days). In an age-adjusted analysis, later intervention was associated with a higher mortality incidence rate than earlier intervention (IR ratio (IRR): 5.53 (95% CI: 1.30 - 23.50), p = 0.02). CONCLUSION: Earlier AST intervention after ICU admission was associated with lower mortality in ICU patients. Proactive and timely stewardship efforts are therefore needed in ICUs.