Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan

Lin, Yu-Shiuan; Lin, I‐Fen; Yen, Yung‐Feng; Lin, Pei-Ching; Shiu, Yu-chih; Hu, Hsing-Yi; Yang, Ying-Pi

doi:10.1016/j.ajic.2013.04.004

Cited by 27 publications

(29 citation statements)

References 27 publications

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“…By extending intervention from cases involving long-term (14 days) antimicrobial use to all cases in which specific antimicrobials were used (an average of 4 days after the initiation of antimicrobial treatment), AST intervention was implemented at an earlier stage of antimicrobial use. Although interventions were weekly, the effects in terms of the use of antimicrobials and cost might be similar to those observed in institutions with daily interventions (Beaulac et al, 2016;Cook and Gooch, 2015;Niwa et al, 2012) and institutions in which interventions are more frequent than once a week (Lin et al, 2013;Storey et al, 2012;Vettese et al, 2013). Table 2 The rate of long-term use of specific antimicrobials (the rate was determined as the number of patients with long-term use divided by the total number of patients with the use of specific antimicrobials).…”

Section: Discussionmentioning

confidence: 89%

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

Hagiwara

Sato

Miyazaki

et al. 2018

International Journal of Infectious Diseases

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Objective: The objective of this study was to evaluate the effects of earlier intervention by an antimicrobial stewardship team (AST) on antimicrobial use, antimicrobial resistance rates, and the clinical outcomes, without changing the weekly intervention schedule. Methods: A retrospective study was conducted at Fukuoka University Hospital between April 2013 and March 2016. The effects were compared among three study periods (SP): SP1 (patients receiving antimethicillin-resistant Staphylococcus aureus agents and carbapenems for 14 days), SP2 (patients receiving specific antimicrobials for 14 days), and SP3 (patients receiving specific antimicrobials regardless of the duration of treatment). Results: The timing of AST intervention was shortened from an average of 15.5 days after administration in SP1 to 4.2 days in SP3. The antimicrobial use density (AUD) of carbapenems and piperacillin-tazobactam decreased significantly (SP2 vs. SP3, p < 0.05), and the costs of specific antimicrobials decreased (SP1, US$ 1 080 000; SP2, US$ 944 000; SP3, US$ 763 000). The rates of carbapenem resistance among Pseudomonas aeruginosa isolates showed a significant reduction from 16.2% in SP2 to 8.7% in SP3 (p < 0.05). The mortality rate and length of stay did not change during the study period. Conclusions: Earlier intervention by an AST could contribute to the proper use of antimicrobials without adversely affecting patient outcomes.

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Section: Discussionmentioning

confidence: 89%

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

Hagiwara

Sato

Miyazaki

et al. 2018

International Journal of Infectious Diseases

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“…As for the 19 studies with data on cost, all reported decreased antimicrobial spending after ASP rollout: nine reported pre- and post-ASP implementation comparisons between antibiotic cost per inpatient-days;23–25 33–35 39 41 42 and 11 reported reductions in antimicrobial purchase costs of between 17% and 69% 22 23 26 29 30 32 33 37–39 43. Finally, only three studies reported annual personnel costs, at $22,092,29 $47,22041 and $121,300 38. None of the 19 studies reporting cost data included information regarding the actual ASP cost.…”

Section: Resultsmentioning

confidence: 99%

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

Mas-Morey

Valle

2017

Eur J Hosp Pharm

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ObjectiveAntimicrobial stewardship programmes (ASPs) have been widely implemented in large hospitals but little is known regarding small-to-medium-sized hospitals. This literature review evaluates outcomes described for ASPs participated in by clinical pharmacists and implemented in small-to-medium-sized hospitals (<500 beds).MethodsFollowing PRISMA principles, PubMed and Cochrane Library databases were searched in early 2016 for English language articles describing implementation and outcomes for inpatient ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. Each included study was required to include at least one of the following outcomes: microbiological outcomes, quality of care and clinical outcomes or antimicrobial use and cost outcomes.ResultsWe included 28 studies from 26 hospitals, mostly American or Canadian. Most cases (23 studies) consisted of time-series comparisons of pre-and post-intervention periods. Of the 28 studies analysed, 8 reported microbiological outcomes, 21 reported quality of care and clinical outcomes, and 27 reported antimicrobial use and cost outcomes. Interventions were not generally associated with significant changes in mortality or readmission rates but were associated with substantial cost savings, mainly due to reduced use of antibiotics or the use of cheaper antibiotics.ConclusionAs far as we are aware, ours is the first systematic review that evaluates ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. ASPs appear to be an effective strategy for reducing antimicrobial use and cost. However, the limited association with better microbiological, care quality and clinical outcomes would highlight the need for further studies and for standardised methods for evaluating ASP outcomes.

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“…The extensive application of ASPs in oncology and/or transplant patients have been associated with decreasing the inappropriate use of antimicrobial and cost reduction without resulting in harm in many countries (7,(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridium difficile infection and amount of antimicrobial consumed in cancer patients

Mardani

Abolghasemi

Shabani

2019

Preprint

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Objective: The objective of this study was to determine the impact of a hospital antimicrobial stewardship on antimicrobial resistant, clostridium difficile rates and amount of antimicrobial consumed in cancer patients. The intervention effects of ASP plans in 2017-2018 and 2018-2019 were respectively evaluated among hematology/oncology and bone morrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (MPM and VMN) consumption gr-year, number of positive clostridium difficile infection and multidrug resistant positive cases in blood cultures.Results: The number of MDR cases in the time periods of 2017-2018 and 2018-2019 were 145 and 75, respectively (p = 0.011). A significant reduction in positive blood cultures from 2017-2018 to 2018-2019 was found (p = 0.001).The amount of MPM prescriptions in 2018-2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms and CDI can highly promote patients' health and decreasing medical costs and longterm defects for patients. Finally, future stewardship studies should made efforts for joining clinical and epidemiological studies.

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Impact of an antimicrobial stewardship program with multidisciplinary cooperation in a community public teaching hospital in Taiwan

Cited by 27 publications

References 27 publications

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

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

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

Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridium difficile infection and amount of antimicrobial consumed in cancer patients

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