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

Abstract

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.

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

“…6). Evaluating the effect on the prevalence of resistant strains derived from infections, methicillin-resistant Staphylococcus aureus (MRSA) infections were significantly lower after the implementation of the ASP based on six studies with follow-up period of 1 year (33, 42, 48) or 2 years (35, 45, 52) (pooled RD ϭ Ϫ0.017, 95% CI ϭ Ϫ0.029 to Ϫ0.005, 2 ϭ 0.03, [Egger's bias ϭ Ϫ1.25, P ϭ 0.280) (33,35,42,45,48,52), and the same was noted for imipenem-resistant Pseudomonas aeruginosa based on five studies with follow-up period of 1 year (33, 42) or 2 years (30, 35, 45, 52) (pooled RD ϭ Ϫ0.079, 95% CI ϭ Ϫ0.114 to Ϫ0.04, 2 ϭ 0.03, Egger's bias ϭ Ϫ0.11, P ϭ 0.918) (30,33,35,45,52) and infections associated with extended-spectrum beta-lactamase (ESBL)-Klebsiella spp. based on five studies with follow-up period of 1 year (33, 42, 48) or 2 years (35, 45) (pooled RD ϭ Ϫ0.104, 95% CI ϭ Ϫ0.153 to Ϫ0.055, 2 ϭ 0.02, Egger's bias ϭ 1.53, P ϭ 0.225) (33,35,42,45,48), whereas a significant decrease was not observed in ESBL-Escherichia coli infections based on five studies with follow-up period of 1 year (33, 42, 48) or 2 years (35, 45) (pooled RD ϭ Ϫ0.009, 95% CI ϭ Ϫ0.044 to 0.055], 2 ϭ 0.02, Egger's bias ϭ Ϫ0.65, P ϭ 0.560) (33,35,42,45,48) (see Fig.…”

Daily Review of Antimicrobial Use Facilitates the Early Optimization of Antimicrobial Therapy and Improves Clinical Outcomes of Patients with Bloodstream Infections

“…8) The international guidelines for the management of severe sepsis and septic shock recommend starting the administration of effective antimicrobial agents within 1 h of recognition of severe sepsis. 20) However, before intervention, antibiotics with a narrow spectrum were administered until results of bacterial culture were obtained.…”

“…7) In August 2009, we implemented a hospital-wide, multidisciplinary intervention program based on this strategy to optimize antibiotic use within 24 h after onset of therapy, which was unique in targeting all patients received intravenous antimicrobials, and found it highly effective in decreasing inappropriate use of antibiotics, reducing the length of hospitalization, reducing the rate of appearance of methicillin-resistant Staphylococcus aureus (MRSA), and reducing medical expenses. 8) Improved patient outcomes are an important benefit of implementing antimicrobial stewardship; however, limited data are available to encourage its general use. 9) In contrast, a delay in the choice of appropriate antibiotic therapy contributes to unfavorable clinical outcomes of patients with infections caused by antibiotic-resistant bacteria, particularly patients with bloodstream infections.…”

Enhancing US-Japan Cooperation to Combat Antimicrobial Resistance

“…Some hospitals in both countries have implemented antimicrobial stewardship programs, [27][28][29] but there is still much work to do to develop better and more widespread practices.…”