Outcome Measurement of the Review System forAppropriate Use of Antimicrobial Injections in All Inpatients Established by the Infection Control Team

Abstract

Antimicrobial resistance in hospitals is increasingly becoming a major problem worldwide, thus appropriate use of antimicrobial agents should be promoted. Since August 2009, our hospital has established a review system for checking prescriptions in all patients receiving antimicrobial injections according to the intervention and feedback of antimicrobial stewardship (AMS) guideline. The antimicrobial use density (AUD), duration of administration, length of hospital stay, and antimicrobial resistance in a year were compared before and after starting the intervention into AMS. Suggestions made by members of the infection control team (ICT) to the prescribers were for the major part the choice and dose elevation of antimicrobials. Most of the proposals (91％) were accepted by the prescribers. Although AUD was not changed after AMS intervention, the proportion of prolonged antimicrobial use (over 2 weeks) was significantly reduced from 5.2％ to 4.1％ (p＝0.007), which led to the saving of costs for antibiotics (4.48 million yen/ year). The incidence of MRSA tended to decrease after AMS intervention (p＝0.074). The median length of hospital stay was ultimately shortened by 1.0 day (p＝0.0005), which led to an estimated saving of medical costs by 520 million yen/year. We consider that our intervention profoundly affects this cost saving. These findings suggest that the extensive intervention into AMS is effective in reducing the frequency of inappropriate use of antimicrobials, suppressing the occurrence of antimicrobial resistance, and saving medical expenses.

Clinical outcomes of intervention for carbapenems and anti-methicillin-resistant Staphylococcus aureus antibiotics by an antimicrobial stewardship team

“…To date, several studies regarding ASP, including recommendations for antibiotic discontinuation, change/de-escalation, addition, and dose adjustment, have been reported. 7,16,22,25 However, most of them have focused on antibiotic usage and have not In our interventions, frequent recommendations were discontinuation and change of antibiotics (most frequent change for carbapenems was de-escalation), rather than performing TDM, also in interventions for anti-MRSA antibiotics (Table 1). This trend was consistent with other studies in which major recommendations were related to the choice of antibiotics.…”

Impact of infection control measures on the related costs and the amount of broad‐spectrum antimicrobial agents used in a hospital: A time‐series analysis

“…In hospitals, an infection control team (ICT) plays an important role on the appropriate use of antimicrobial agents and antiseptics based on AMS. Infection control measures implemented by an in‐hospital ICT are essential for preventing HAIs caused by MRSA . These infection control measures include promoting hand sanitization with quick‐drying antiseptics and appropriate use of medical supplies, such as disposable gloves and gowns .…”

“…For instance, a correlation has been reported between the amount of carbapenems used and number of patients with MRSA infections , suggesting that the use of broad‐spectrum antimicrobial agents should be limited to cases with indications and should be used appropriately to prevent HAIs caused by MRSA. In terms of the impact of ICT, reports suggest that infection control measures implemented by an ICT may significantly reduce the number of patients receiving long‐term antimicrobial therapy, amount of carbapenems used, costs associated with antimicrobial agents and general hospitalization, and MRSA detection rates . Modification of antimicrobial use implemented by an ICT is important for controlling HAIs .…”