The Impact of Antimicrobial Stewardship by Infection Control Team in a Japanese Teaching Hospital

Abstract

The objective of this study is to investigate an eŠect on the antimicrobial appropriate use of the antimicrobial stewardship. We investigated the consumption of injectable antimicrobials from 2001 to 2007 and the administration period of speciˆc antimicrobials (carbapenems, fourth-generation cephalosporins, anti-methicillin-resistant Staphylococcus aureus (MRSA) agents) in the individual patient. Since September 2004, the infection control team at Osaka University Hospital has been promoting appropriate use of antimicrobials through consultation, education, and weekly surveillance of speciˆc antimicrobial usage. We obtained the amount of all antimicrobial injections as titer from the medical information database of the electronic medical chart system retrospectively. Antimicrobial use densities (AUD) were evaluated by measuring the number of doses administered/1000 patient-days. Although the number of inpatient admissions and operations increased 1.53-and 1.39-fold, respectively, in the seven years from 2001 to 2007, the expenditure on speciˆc antimicrobials decreased markedly with AUD of speciˆc antimicrobials decreasing from 39.6 to 29.2. The percentage of inpatients receiving speciˆc antimicrobials decreased from 19.8％ to 9.8％, and the ratio of the number of inpatients administered a speciˆc antimicrobial within seven days to the number of inpatients administered each speciˆc antimicrobial increased to over 60％. This led to reduction in the total expenditure of antimicrobials by about \100 million annually. The incidence of hospital-associated MRSA (HA-MRSA) infection decreased from 0.93％ (2003) to 0.68％ (2007). We can reduce the expenditure of antimicrobials without increasing incidence of the HA-MRSA by antimicrobial stewardship, and we think that appropriate use of antimicrobials is achieved progressively.

The need for cost-effectiveness analyses of antimicrobial stewardship programmes: A structured review

“…conversion (1). Of the 36 included studies, 2 were full CEAs [13,14]; 27 studies reported changes to costs and health outcomes separately [3,5,[8][9][10][12][13][14][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and 9 reported only changes to costs [4,6,[15][16][17][18][19][20][21]. Table 1 presents the methods and results for studies that measured only cost outcomes and Table 2 presents the methods and findings of those studies that measured both a clinical as well as a cost outcome.…”

“…One study also noted cost savings associated with the reduction in LOS [10]. Ten of the twelve studies reported the TAE [3,8,10,22,23,25,26,[28][29][30], whilst one study reported TAE per admission [24] and one reported findings as TAE per 1000 PDs [27]. One study also specifically mentioned that a saving of $194 160 [3] was achieved by i.v.-to-p.o.…”

Correlation between the Consumption of Meropenem or Doripenem and Meropenem Susceptibility of <i>Pseudomonas aeruginosa</i> in a University Hospital in Japan

“…The antimicrobial therapy based on pharmacokinetics-pharmacodynamics theory is performed progressively, and the administration period of carbapenems became shorter by this action. 12) Although there was no significant change in the annual number of isolated P. aeruginosa, the annual number of MDR P. aeruginosa was markedly decreased by the measures against nosocomial infection. In this study, the total consumption of meropenem was correlated with the rate of meropenem-resistant P. aeruginosa.…”

Antimicrobial Use, Prescribing, and Resistance in Selected Ten Selected Developing Countries: A Brief Overview

“…Same study and several other studies conveyed that irrational prescription of medicine including antimicrobials possibly will result in poor health status and enormous financial impact for any community or country [57][58][59][60][61]. Antimicrobials alone took the share 30-50% of all prescribed medicine in quite a lot of countries [58,62]. Research Center, Shiraz, Iran reported in Editorial in the most prestigious medical journal the Lancet that "antibiotics are an important front-line instrument in the fight against various infectious diseases.…”