Reduction in antimicrobial use associated with a multifaceted antimicrobial stewardship programme in a tertiary teaching hospital in Shanghai: a segmented regression analysis

Abstract

Background: Rational use of antibiotics received great attention in China, therefore the multifaceted antimicrobial stewardship (MAMS) is urgently required in hospital management. We conducted this study to assess the impact of a MAMS programme on antimicrobial use in a tertiary teaching hospital in Shanghai.Methods: This retrospective observational study was conducted at a tertiary teaching hospital in Shanghai. The MAMS programme involved multifaceted interventions consisting of a quality premium with financial incentives, antibiotic restriction, audit and feedback, and education. Data were extracted from the electronic medical records of inpatients to analyse monthly and annual antibiotic consumption and the percentage of antibiotic prescriptions during 2017-2020. Segmented regression analysis of the interrupted time series was used to contrast antimicrobial use during 2019-2020, with non-MAMS data from the 2017-2018 period as the historical control. Results: With MAMS implementation, antibiotic consumption decreased from 63.3 (59.3, 67.2) defined daily doses (DDDs) per 100 patient-days (PD) to 43.3 (39.0, 49.8) DDDs/100 PD (P<0.001), and the percentage of antibiotic prescriptions decreased from 44.8% (44.1%, 45.4%) to 43.3% (42.2%, 44.3%) (P<0.001). Segmented regression models suggested a reduction in antibiotic consumption (coefficient = -12.537, P<0.001) and indicated a downward trend in the percentage of antibiotic prescriptions (coefficient =-0.165, P=0.049). Neither antibiotic consumption nor the percentage of antibiotic prescriptions was influenced by the coronavirus disease 2019 (COVID-19) pandemic.Conclusions: This study suggests that MAMS plays an important role in reducing antibiotic use and is not affected by special circumstances such as the COVID-19 pandemic. This novel intervention, consisting of a quality premium and multidisciplinary cooperation, should be prioritized by policy and decision makers, where rational management of antimicrobial use is urgently needed.

Effect of the COVID-19 pandemic on antibiotic consumption: A systematic review comparing 2019 and 2020 data

“…Full text of remaining 66 articles were reviewed, and finally, 16 articles were included in this systematic review ( 13 – 28 ) ( Figure 1 ). Eight studies reported only hospital-based results ( 13 , 14 , 23 – 28 ), nine reported only community-level antibiotic consumption ( 14 – 22 ), and one [conducted in England ( 14 )] reported antibiotic consumption in both hospitals and communities ( Tables 2 , 3 ). Although we did not limit the studies to the year 2020, we could not find any study that reported antibiotic consumption in 2021 through the systematic review.…”

“…These studies, except for Murgadella-Sancho et al, reported an increase in antibiotic consumption in 2020. Only one study from China reported that the continuous implementation of antibiotic stewardship programs since 2019 throughout 2020 resulted in the reduction of overall antibiotic consumption in 2020 ( 23 ).…”

“…The economies of countries were categorized according to the World Bank country and lending groups ( 29 ). Hospital-based studies have been conducted in high-income economies (Spain, Italy, and the UK), upper-middle-income economies (Lebanon and China), and lower-middle-income economies (India and Brazil) ( 13 , 14 , 23 – 28 ). All community-based studies were conducted in high-income countries, except Jordan, an upper-middle-income economy ( 14 – 22 ).…”

“…Our systematic review results revealed a consistent decrease in community antibiotic consumption ( 14 – 22 ). In contrast, more studies reported an increase in overall hospital antibiotic consumption in 2020 compared with that in 2019 ( 13 , 14 , 23 – 28 ). Multiple hospital-based studies reported the interruption of antibiotic stewardship programs in 2020 because of the allocation of infection control specialists for COVID-19, which resulted in increased overall antibiotic consumption ( 13 , 14 , 25 ).…”

Antimicrobial Stewardship in Surgery: A Literature Bibliometric Analysis

“…Additionally, the current status of AMS management in surgery is of major significance to the rational use of antibiotics in the future. Our former studies have finished to build a management and control mode in comprehensive hospital AMS ( 8 ), however, AMS management from surgical perspective is lacking. Therefore, we performed this study to provide a structured analysis of AMS research in the surgical field both from macroscopic and microscopic aspects, to infer future trends and identify shifts in this field.…”