Influencing the use of antibiotics in a Chinese pediatric intensive care unit

Ding, Hui; Yang, Yonghong; Wei, Jinghai; Fan, Shaozhen; Yu, Sangjie; Yao, Kaihu; Wang, Aihua; Shen, Xuzhuang

doi:10.1007/s11096-008-9220-9

Cited by 30 publications

(58 citation statements)

References 22 publications

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“…In the present study, we surveyed a short‐term effect of the present intervention and found that the proportion of MRSA against total isolated S. aureus and the proportion of S. marcescens against GNR significantly decreased during an active intervention period, although slight and no significant reduction in the antimicrobial‐resistant P. aeruginosa was observed. However, the occurrence of imipenem‐resistant P. aeruginosa was reported to be approximately 17% (26) or 21.7% (27) before implementation of antimicrobial stewardship. But, the rates of the appearance of these resistant bacteria were consistently low (< 10%) in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital

Niwa

Shinoda

Suzuki

et al. 2012

International Journal of Clinical Practice

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BackgroundAntimicrobial stewardship has not always prevailed in a wide variety of medical institutions in Japan.MethodsThe infection control team was involved in the review of individual use of antibiotics in all inpatients (6348 and 6507 patients/year during the first and second annual interventions, respectively) receiving intravenous antibiotics, according to the published guidelines, consultation with physicians before prescription of antimicrobial agents and organisation of education programme on infection control for all medical staff. The outcomes of extensive implementation of antimicrobial stewardship were evaluated from the standpoint of antimicrobial use density, treatment duration, duration of hospital stay, occurrence of antimicrobial-resistant bacteria and medical expenses.ResultsProlonged use of antibiotics over 2 weeks was significantly reduced after active implementation of antimicrobial stewardship (2.9% vs. 5.2%, p < 0.001). Significant reduction in the antimicrobial consumption was observed in the second-generation cephalosporins (p = 0.03), carbapenems (p = 0.003), aminoglycosides (p < 0.001), leading to a reduction in the cost of antibiotics by 11.7%. The appearance of methicillin-resistant Staphylococcus aureus and the proportion of Serratia marcescens to Gram-negative bacteria decreased significantly from 47.6% to 39.5% (p = 0.026) and from 3.7% to 2.0% (p = 0.026), respectively. Moreover, the mean hospital stay was shortened by 2.9 days after active implementation of antimicrobial stewardship.ConclusionExtensive implementation of antimicrobial stewardship led to a decrease in the inappropriate use of antibiotics, saving in medical expenses, reduction in the development of antimicrobial resistance and shortening of hospital stay.

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Section: Discussionmentioning

confidence: 99%

Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital

Niwa

Shinoda

Suzuki

et al. 2012

International Journal of Clinical Practice

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“…Ding et al observed that introduction of guidelines and education of doctors had a significant impact on antibiotic prescribing habits in a paediatric intensive care unit [32]. Moreover, Zhang et al associated the decline in antibiotic use in the paediatric population due to the impact of national guidelines [33].…”

Section: Discussionmentioning

confidence: 99%

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

et al. 2009

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In an attempt to ensure cost-effective prophylactic use of antibiotics in caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of 'third' generation of cephalosporin's whereas the use of "older" antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.

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“…The Yates continuity correction was performed when the expected frequencies were <5 [22]–[23]. Trend analysis was performed to evaluate the cost outcomes of patients using simple linear regression analysis [24]. p <0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Pharmacist Interventions for Prophylactic Antibiotic Use in Urological Inpatients Undergoing Clean or Clean-Contaminated Operations in a Chinese Hospital

Zhang

Huo

et al. 2014

PLoS ONE

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ObjectivesTo evaluate the impact and cost-benefit value of pharmacist interventions for prophylactic antibiotic use in surgical patients undergoing clean or clean-contaminated operations.MethodsA pre-to-post intervention study was performed in the Department of Urological Surgery of a tertiary hospital. Patients admitted from January through June 2011, undergoing clean or clean-contaminated surgery, served as the pre-intervention group; patients admitted from January through June 2012 formed the post-intervention group. Pharmacist interventions were performed for the surgeries in the post-intervention group. The criteria for the rational use of antibiotic prophylaxis were established by the hospital administration. The pharmacist interventions included real-time monitoring of medical records and controlling of the prescriptions of prophylactic antibiotics against the criteria. The pre- and post-intervention groups were then compared to evaluate the outcomes of the pharmacist interventions. A cost-benefit analysis was performed to determine the economic effects of implementing the pharmacist intervention on preoperative antibiotic prophylaxis.ResultsAfter the pharmacist intervention, a significant decrease was found in the rate of no indications for prophylactic antibiotic use (p = 0.004), the rate of broad-spectrum antibiotic use (p<0.001), the rate of drug replacement (p<0.001) and the rate of prolonged duration of prophylaxis (p<0.001). Significant reductions were observed in the mean antibiotic cost (p<0.001), the mean duration of antibiotic prophylaxis (p<0.001) and the mean number of antibiotics used (p<0.001). A significant increase was observed in the rate of correct choice of antibiotics (p<0.001). The ratio of the net mean cost savings for antibiotics to the mean cost of pharmacist time was approximately 18.79∶1.ConclusionReal-time interventions provided by a clinical pharmacist promoted rational use of prophylactic antibiotics, with a significant reduction in antibiotic costs, thus leading to favorable economic outcomes.

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Influencing the use of antibiotics in a Chinese pediatric intensive care unit

Abstract: Our interventions led to a significant reduction of broad-spectrum antibiotic prescribing associated with the significant reduction in bacterial resistance in the PICU. The implementation of the antibiotics guideline appeared to be effective.

Cited by 30 publications

References 22 publications

Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital

Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

Pharmacist Interventions for Prophylactic Antibiotic Use in Urological Inpatients Undergoing Clean or Clean-Contaminated Operations in a Chinese Hospital

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