2018 年 44 巻 5 号 p. 222-228
Blood culture collection is strongly recommended prior to the start of broad spectrum antibiotics. Once causative organisms are identified, the narrow spectrum antibiotics are introduced (de-escalation). In Fukuoka Red Cross Hospital, the infection control team (ICT) has been encouraging doctors to take 2 sets of blood culture, prior to the commencement of carbapenem. We compared the implementation of blood culture collection prior to the commencement of carbapenem from 2013 to 2016. During this period, the implementation rate was increased from 33.0％ to 71.1％ (P < 0.05), respectively. The de-escalation was also improved from 10.3％ to 33.0％ (P < 0.05), in the respective period. The cost in the use of carbapenem in 2016 was significantly decreased. This cost effectiveness showed a positive outcome when de-escalation took place, compared with a simulated case of continuous use of carbapenem. The total pharmaceutical cost reduction over this period was increased from 136,437 yen to 547,205 yen. The result showed the endorsement of mandatory blood culture collection prior to carbapenem use improved de-escalation as well as pharmaceutical cost.
