{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T12:31:37Z","timestamp":1781008297700,"version":"3.54.1"},"reference-count":41,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,9]],"date-time":"2024-11-09T00:00:00Z","timestamp":1731110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Antimicrobial stewardship (AS) Guidelines by the Infectious Diseases Society of America recommend employing prospective audit and feedback (PAF) as an effective intervention in AS programs. Since July 2022, our hospital has implemented PAF for all patients with positive blood cultures, including those with extended-spectrum \u03b2-lactamase (ESBL)-producing Escherichia coli (EC) bacteremia. Our study examined the effect of PAF on clinical outcomes in patients with ESBL-EC bacteremia. We enrolled 62 patients diagnosed with ESBL-EC via blood culture who were undergoing antibiotic treatment. The patients were divided into the pre-PAF and post-PAF implementation groups. The rate of antibiotic de-escalation from broad-spectrum antibiotics to narrow-spectrum cefmetazole was significantly higher in the post-PAF group than in the pre-PAF group (80.7% vs. 32.4%, p = 0.0003). The treatment failure rate in the pre-PAF group was higher than that in the post-PAF group (38.7% vs. 12.9%, p = 0.04). The results of this study indicate that the implementation of PAF is advantageous not only in terms of process indicators but also in improved clinical outcomes, including reduced treatment failure rates. We hope that this study will encourage the implementation of PAF in more facilities to instigate a collective effort to reduce the incidence of antimicrobial resistance.<\/jats:p>","DOI":"10.3390\/microorganisms12112275","type":"journal-article","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T08:01:27Z","timestamp":1731312087000},"page":"2275","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of Prospective Audit and Feedback in Patients with Extended-Spectrum \u03b2-Lactamase-Producing Escherichia coli Bacteremia"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6297-6388","authenticated-orcid":false,"given":"Yota","family":"Yamada","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Infection Control and Prevention, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4526-3045","authenticated-orcid":false,"given":"Motoyasu","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Infection Control and Prevention, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Hospital Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisako","family":"Kushima","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitomi","family":"Hirata","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Infection Control and Prevention, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arata","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Infection Control and Prevention, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukie","family":"Komiya","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Clinical Laboratory, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7953-2949","authenticated-orcid":false,"given":"Akio","family":"Nakashima","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Hospital Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2143-5922","authenticated-orcid":false,"given":"Hiroshi","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Imakyure","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Fukuoka University Chikushi Hospital, Fukuoka 818-8502, Japan"},{"name":"Department of Hospital Pharmacy, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.1469-0691.2007.01855.x","article-title":"Prevalence and clonality of extended-spectrum beta-lactamases in Asia","volume":"14","author":"Hawkey","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/j.1469-0691.2007.01850.x","article-title":"Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe","volume":"14","author":"Novais","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.ijmm.2017.07.004","article-title":"Relevance of multidrug-resistant Pseudomonas aeruginosa infections in cystic fibrosis","volume":"307","author":"Stefani","year":"2017","journal-title":"Int. J. Med. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"ref_5","first-page":"1","article-title":"Antimicrobial resistance: Tackling a crisis for the health and wealth of nations","volume":"20","year":"2014","journal-title":"Rev. Antimicrob. Resist."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S1473-3099(16)30127-X","article-title":"Reflecting on the final report of the O\u2019Neill review on antimicrobial resistance","volume":"16","author":"Piddock","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Salgado-Caxito, M., Benavides, J.A., Adell, A.D., Paes, A.C., and Moreno-Switt, A.I. (2021). Global prevalence and molecular characterization of extended-spectrum \u03b2-lactamase producing Escherichia coli in dogs and cats\u2014A scoping review and meta-analysis. One Health, 12.","DOI":"10.1016\/j.onehlt.2021.100236"},{"key":"ref_8","unstructured":"Centers for Disease Control and Prevention (CDC) (2024, April 11). ESBL-Producing Enterobacterales, Available online: https:\/\/www.cdc.gov\/esbl-producing-enterobacterales\/about\/index.html."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1128\/CMR.18.4.657-686.2005","article-title":"Extended-spectrum \u03b2-lactamases: A clinical update","volume":"18","author":"Paterson","year":"2005","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1001\/archinte.168.17.1897","article-title":"Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli","volume":"168","author":"Cisneros","year":"2008","journal-title":"JAMA Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/jac\/dkw419","article-title":"Community carriage of ESBL-producing Escherichia coli is associated with strains of low pathogenicity: A Swedish nationwide study","volume":"72","author":"Ny","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"D\u00edaz-Agero P\u00e9rez, C., L\u00f3pez-Fresneda, N., Rincon Carlavilla, A.L., Hern\u00e1ndez Garc\u00eda, M., Ruiz-Garbajosa, P., Aranaz-Andr\u00e9s, J.M., Maechler, F., Gastmeier, P., Bonten, M.J.M., and Canton, R. (2019). Local prevalence of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae intestinal carriers at admission and co-expression of ESBL and OXA-48 carbapenemase in Klebsiella pneumoniae: A prevalence survey in a Spanish University Hospital. BMJ Open, 9.","DOI":"10.1136\/bmjopen-2018-024879"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/tmi.12824","article-title":"Intense pre-admission carriage and further acquisition of ESBL-producing Enterobacteriaceae among patients and their caregivers in a tertiary hospital in Rwanda","volume":"22","author":"Kurz","year":"2017","journal-title":"Trop. Med. Int. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.jiac.2018.04.016","article-title":"Clinical characteristics and outcome of critically ill patients with bacteremia caused by extended-spectrum beta-lactamase producing and non-producing Escherichia coli","volume":"24","author":"Haruki","year":"2018","journal-title":"J. Infect. Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lee, C.C., Wang, J.L., Lee, C.H., Hung, Y.P., Hong, M.Y., Chang, C.M., and Ko, W.C. (2017). Age-related trends in adults with community-onset bacteremia. Antimicrob. Agents Chemother., 61.","DOI":"10.1128\/AAC.01050-17"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.jhin.2015.10.001","article-title":"Impact of infection with extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella species on outcome and hospitalization costs","volume":"92","author":"Maslikowska","year":"2016","journal-title":"J. Hosp. Infect."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jgar.2016.03.006","article-title":"An institutional review of antimicrobial stewardship interventions","volume":"6","author":"Cao","year":"2016","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1093\/cid\/ciw217","article-title":"Executive summary: Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/cid\/ciw118","article-title":"Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America","volume":"62","author":"Barlam","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","unstructured":"Joint Committee for the Promotion of Appropriate Use of Antimicrobials by Eight Academic Societies (2017). Guidance for implementing an antimicrobial stewardship program in Japan. Jpn. J. Chemother., 65, 650\u2013687."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1016\/j.ajic.2022.01.015","article-title":"Impact of continuous pharmacist intervention for injectable antimicrobials on the treatment of patients with Escherichia coli bacteremia","volume":"50","author":"Shinoda","year":"2022","journal-title":"Am. J. Infect. Control"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Yamaguchi, R., Yamamoto, T., Okamoto, K., Tatsuno, K., Ikeda, M., Tanaka, T., Wakabayashi, Y., Sato, T., Okugawa, S., and Moriya, K. (2022). Prospective audit and feedback implementation by a multidisciplinary antimicrobial stewardship team shortens the time to de-escalation of anti-MRSA agents. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0271812"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1111\/j.1469-0691.2009.02901.x","article-title":"Severity of illness scoring systems in patients with bacteraemic pneumococcal pneumonia: Implications for the intensive care unit care","volume":"15","author":"Feldman","year":"2009","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0924-8579(98)00060-0","article-title":"Combination antibiotic therapy versus monotherapy for gram-negative bacteraemia: A commentary","volume":"11","author":"Chow","year":"1999","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.ajic.2015.12.016","article-title":"Antimicrobial stewardship for carbapenem use at a Japanese tertiary care center: An interrupted time series analysis on the impact of infectious disease consultation, prospective audit, and feedback","volume":"44","author":"Tagashira","year":"2016","journal-title":"Am. J. Infect. Control."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.jiac.2020.10.006","article-title":"Impact of an infectious disease physician-led carbapenem postprescription feedback on prescribing behavior in a Japanese tertiary hospital: A before-after study","volume":"27","author":"Matono","year":"2021","journal-title":"J. Infect. Chemother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1086\/664757","article-title":"Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: A controlled interrupted time series analysis","volume":"33","author":"Elligsen","year":"2012","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S1473-3099(08)70041-0","article-title":"Extended-spectrum beta-lactamase-producing Enterobacteriaceae: An emerging public-health concern","volume":"8","author":"Pitout","year":"2008","journal-title":"Lancet Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.jiac.2023.10.007","article-title":"Comparative effectiveness of cefmetazole versus carbapenems and piperacillin\/tazobactam as initial therapy for bacteremic acute cholangitis: A retrospective study","volume":"30","author":"Aoto","year":"2024","journal-title":"J. Infect. Chemother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jiac.2018.02.011","article-title":"Antimicrobial susceptibility of common pathogens isolated from postoperative intra-abdominal infections in Japan","volume":"24","author":"Takesue","year":"2018","journal-title":"J. Infect. Chemother."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"635","DOI":"10.14740\/jocmr3928","article-title":"Change in the antimicrobial resistance profile of extended-spectrum \u03b2-lactamase-producing Escherichia coli","volume":"11","author":"Miyazaki","year":"2019","journal-title":"Clin. Med. Res."},{"key":"ref_33","first-page":"539","article-title":"Antimicrobial treatment duration and outcomes in patients with bacteremia caused by extended-spectrum \u03b2-lactamase-producing Gram-negative bacteria: A single-center retrospective study","volume":"68","author":"Nakakura","year":"2020","journal-title":"Jpn. J. Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/j.cmi.2018.01.013","article-title":"Treatment duration for Escherichia coli bloodstream infection and outcomes: Retrospective single-center study","volume":"24","author":"Giannella","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1093\/cid\/cix767","article-title":"Comparing the outcomes of adults with Enterobacteriaceae bacteremia receiving short-course versus prolonged-course antibiotic therapy in a multicenter, propensity score\u2013matched cohort","volume":"66","author":"Chotiprasitsakul","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.cmi.2017.02.027","article-title":"Impact of inadequate initial antimicrobial therapy on mortality in patients with bacteraemic cholangitis: A retrospective cohort study","volume":"23","author":"Tagashira","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.jinf.2009.12.007","article-title":"Recurrent bacteraemia: A 10-year regional population-based study of clinical and microbiological risk factors","volume":"60","author":"Jensen","year":"2010","journal-title":"J. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1111\/j.1469-0691.2011.03587.x","article-title":"Risk factors for recurrence and death after bacteraemia: A population-based study","volume":"17","author":"Jensen","year":"2011","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s10096-010-1057-1","article-title":"Clinical and molecular epidemiology of extended-spectrum \u03b2-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a long-term study from Japan","volume":"30","author":"Chong","year":"2011","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Akine, D., Sasahara, T., Kiga, K., Ae, R., Kosami, K., Yoshimura, A., Kubota, Y., Sasaki, K., Kimura, Y., and Ogawa, M. (2021). Distribution of extended-spectrum beta-lactamase genes and antimicrobial susceptibility among residents in geriatric long-term care facilities in Japan. Antibiotics, 11.","DOI":"10.3390\/antibiotics11010036"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1016\/j.jiac.2021.07.009","article-title":"Retrospective evaluation of appropriate dosing of cefmetazole for invasive urinary tract infection due to extended-spectrum beta-lactamase-producing Escherichia coli","volume":"27","author":"Hamada","year":"2021","journal-title":"J. Infect. Chemother."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/11\/2275\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:29:23Z","timestamp":1760113763000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/11\/2275"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,9]]},"references-count":41,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["microorganisms12112275"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms12112275","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,9]]}}}