Evaluation of Implementation and Effectiveness of China’s Antibiotic Stewardship in the First Affiliated Hospital of Sun Yat-sen University

Abstract

Antibiotic stewardship has been prioritized by governments and health care organizations in recent years as antibiotic resistance is markedly increasing. A tertiary hospital in Guangzhou, China was chosen as a study example to undertake an implementation and effectiveness evaluation of China’s antibiotic stewardship to improve and promote antimicrobial stewardship nationwide. The general surgery department of the study hospital was utilized to examine surgical site infection, and samples from across the hospital were used to identify bloodstream infection. Data was analyzed using descriptive analysis, the Mann–Kendall trend test, logit model and panel data model, and t-tests. In terms of prophylactic and therapeutic antibiotic rational use, respectively, we evaluated implementation conditions, the correlation between implementation and corresponding disease progress, and the cost-effectiveness of China’s antibiotic stewardship. For perioperative prophylactic antibiotic use, antibiotic stewardship was found to have been well-implemented, cost-effective, and reduced the incidence of surgical site infection. However, concerning therapeutic use and antibiotic-resistant bacterial infection prophylaxis, the complexity of influencing factors and the contradiction between stewardship implementation and clinical demand needs to be further evaluated.

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

“…ASPs brought about positive clinical outcomes in hospital inpatients in most cases. Microbiological outcomes to assess the impact of ASP were reported in 42% (22/53) of studies [ 63 , 65 , 66 , 71 , 76 , 79 , 81 – 85 , 87 – 89 , 100 , 101 , 109 , 110 ], including a decrease in the prevalence of multi-drug resistance bacterial strains like Acinetobacter spp , Methicillin-Resistant Staphylococcus aureus (MRSA) , Vancomycin-Resistant Enterococcus [VRE], increase in the antibiotic susceptibility of bacterial strains such as Pseudomonas aeruginosa, E. coli [ 71 , 81 , 82 , 85 ]. Studies also documented a reduction in the incidence of bacterial infections such as Clostridioides difficile infections and Candidemia [ 75 , 77 ], and a decrease in pan-drug resistant isolates [ 65 , 71 , 77 , 85 ].…”

“…Studies also documented a reduction in the incidence of bacterial infections such as Clostridioides difficile infections and Candidemia [ 75 , 77 ], and a decrease in pan-drug resistant isolates [ 65 , 71 , 77 , 85 ]. Economic outcomes were assessed in 17 studies [ 39 , 65 , 69 , 71 , 81 , 86 , 88 – 90 , 93 , 94 , 96 , 100 , 103 , 104 , 107 , 110 ], and reported a decrease in hospital antibiotic procurement cost [ 65 , 71 , 81 , 90 , 93 , 94 ], savings in antibiotic costs [ 39 , 69 , 86 , 88 , 104 , 110 ], decrease in antibiotic therapy and antibiotic prophylaxis cost [ 67 , 107 ], and hospitalization costs [ 110 ].…”