Contribution of antimicrobial stewardship programs to reduction of antimicrobial therapy costs in community hospital with 429 Beds --before-after comparative two-year trial in Japan

Abstract

ObjectivesDo antimicrobial stewardship programs (ASPs) contribute to reduction of antimicrobial therapy costs in Japanese community hospitals? To answer this health economic question, a before-after comparative two-year trial in a community hospital in the country was designed.MethodsThe study was conducted at National Hospital Organization Tochigi Medical Center, a community hospital with 429 beds. We compared six-month period before-ASP (January 2010 to June 2010) and 24-month period after ASP (July 2010 to June 2012) in primary and secondary outcome measures. Three medical doctors, three pharmacists and two microbiology technologists participate in the ASPs. The team then provided recommendations based on the supplemental elements to primary physicians who prescribed injectable antimicrobials. Prospective audit with intervention and feedback was applied in the core strategy while dose optimization, de-escalation and recommendations for alternate agents and blood cultures were applied in the supplemental elements. The primary outcome was measured by the antimicrobial therapy costs (USD per 1,000 patient-days), while the secondary outcomes included the amount of antimicrobials used (defined daily doses per 1,000 patient-days), sensitivity rates (%) of Pseudomonas aeruginosa (P. aeruginosa) to Meropenem (MEPM), Ciprofloxacin (CPFX) and Amikacin (AMK), length of stay (days) and detection rates (per 1,000 patient-day) of methicillin-resistant Staphylococcus aureus (MRSA) and extended spectrum beta-lactamase-producing organisms (ESBLs) through blood cultures.ResultsIn the study, recommendations were made for 465 cases out of 1,427 cases subject to the core strategy, and recommendations for 251 cases (54.0%) were accepted. After ASP, the antimicrobial therapy costs decreased by 25.8% (P = 0.005) from those before ASP. Among the secondary outcomes, significant changes were observed in the amount of aminoglycosides used, which decreased by 80.0% (P < 0.001) and the detection rate of MRSA, which decreased by 48.3% (P < 0.001).ConclusionsThe study suggested the possibility that ASPs contributed to the reduction of the antimicrobial therapy costs in a community hospital with 429 beds.

A systematic review of inpatient antimicrobial stewardship programmes involving clinical pharmacists in small-to-medium-sized hospitals

“…Two studies reported a significant decrease in the annual C. difficile rate: from 0.11 to 0.07 per 1000 patient-days21 and from 5.5 to 1.6 cases per 10 000 patient-days 24. Finally, contradictory results were reported for MRSA infections, with two studies reporting a decrease in monthly rates from 2.9 to 1.5 cases per 1000 patient-days25 and a decrease from 50% to 34% of all clinical isolates,26 but with two other studies reporting higher rates of MRSA infections in the post-intervention period27 28 and a decrease in the number of patients with vancomycin-resistant Enterococcus infection (from 10 to 2 cases annually), while the number of patients with vancomycin-susceptible Enterococcus infection increased 28…”

The impact of earlier intervention by an antimicrobial stewardship team for specific antimicrobials in a single weekly intervention

“…As described in the IDSA guidelines for ASPs, the monitoring of anti-infective treatment and the provision of feedback are recommended, regardless of the period of use (Barlam et al, 2016). Many reports investigating the effects of intervention have reported effects such as decreased antimicrobial use and reduced rates of drug resistance (Beaulac et al, 2016;Fukuda et al, 2014;Niwa et al, 2012;Vettese et al, 2013). However, there are few reports on the effects of changing the timing of intervention.…”

“…The possibility that fluctuation of antimicrobial resistance rates could be influenced by many more factors, including infection control, rather than by decreased antimicrobial use alone, should also be taken into consideration. Although reports have shown the decreasing use of antimicrobials and cost reductions as a result of once a week intervention (Fukuda et al, 2014;Jenkins et al, 2015;Tagashira et al, 2016), more appropriate timing of intervention by PAF to enhance the effects of the AST, or the problem of the labor burden and manpower, remain the subject for further study.…”

Implementasi Antimicrobial Stewardship Program di Kawasan Asia: Sebuah Kajian Sistematis

“…Penggunaan prospective audit with intervention and feedback sebagai intervensi utama ASP dijumpai pada sebanyak 17 artikel (73,91%). [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]52 Terdapat satu artikel yang memaparkan kombinasi dua intervensi utama yang secara bergantian diimplementasikan pada dua periode penelitian yang berbeda. 50…”

“…NA India (n=1) 28 Cina (n=3) 29,30,55 Thailand (n=2) 31,32 Taiwan (n=7) [33][34][35][36][37][38][39] Singapura (n=6) [40][41][42][43][44][45] Jepang (n=5) [46][47][48][49][50] Hong Kong (n=2) 52,53 Korea (n=1) 54 Saudi Arabia (n=1) 51 Keterangan: NA=not-available Pada kajian sistematis ini, jenis intervensi prospective audit with intervention and feedback diimplementasikan pada 20 dari total 28 artikel terkait ASP di kawasan Asia. Terdapat beberapa kemungkinan penyebab implementasi formulary restriction and preauhorization tidak sebanyak prospective audit with intervention and feedback.…”