The need for an antibiotic stewardship program in a hospital using a computerized pre-authorization system

Abstract

Objectives: Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are pre-authorization and prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) has been in place since 2003. The aim of this study was to measure the effect of a prospective audit and feedback strategy system along with the NARP. Methods: A prospective quasi-experimental study was designed and implemented between March and June 2017. A computerized pre-authorization system was used as an ASP strategy to approve the antibiotics. During the baseline period, patients with intravenous (IV) antibiotic use 72 h were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physicians in the case of IV antibiotic use 72 h. The modified criteria of Kunin et al. and Gyssens et al. were followed for appropriateness of prescribing. Days of therapy (DOT) and length of stay (LOS) were calculated and compared between the two study periods. Results: A total of 866 antibiotic episodes among 519 patients were observed. A significant reduction in systemic antibiotic consumption was observed in the intervention period (575 vs. 349 DOT per 1000 patient-days; p < 0.001). On multivariate analysis, prospective audit and feedback (odds ratio 1.5, 95% confidence interval 1.09-2.04; p = 0.011) and pre-authorization of restricted antibiotics (odds ratio 1.7; 95% confidence interval 1.2-2.31; p = 0.002) were the predictors of appropriate antimicrobial use. Mean LOS was decreased by 2.9 days (p = 0.095). Conclusions: This study showed that the antimicrobial restriction program alone was effective, but the system should be supported by a tailored ASP, such as prospective audit and feedback.

Current Status of Antimicrobial Stewardship Programs in São Paulo Hospitals

“…Another disadvantage of pre-authorization is the need for a full-time ID physician consultation. However, it usually provides stricter control of antimicrobial usage (7). We observed that physicians consider the decrease in antimicrobial resistance as the most relevant impact of implementing ASPs.…”

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

“…To assess the impact of ASP interventions, 24 studies (45%, 24/53) assessed clinical or patient-centered outcomes [ 62 – 64 , 66 , 67 , 69 , 73 – 75 , 77 , 79 – 81 , 86 – 88 , 97 , 100 – 104 , 106 – 108 ]. Metrics used to evaluate the intervention included length of stay in hospital (LOS) in specific units (e.g., ICU) [ 46 , 62 , 68 , 69 , 73 , 74 , 76 , 77 , 81 , 86 , 88 , 96 , 101 – 103 ], hospital mortality [ 62 , 76 , 77 , 80 , 86 , 100 – 102 , 106 ], rehospitalization [ 77 , 81 , 83 , 86 , 104 ], hospital-acquired infections [ 63 , 64 , 67 , 81 , 97 , 107 , 109 ], and device-associated infections [ 64 ]. ASPs brought about positive clinical outcomes in hospital inpatients in most cases.…”

“…Studies also documented a reduction in the incidence of bacterial infections such as Clostridioides difficile infections and Candidemia [ 75 , 77 ], and a decrease in pan-drug resistant isolates [ 65 , 71 , 77 , 85 ]. Economic outcomes were assessed in 17 studies [ 39 , 65 , 69 , 71 , 81 , 86 , 88 – 90 , 93 , 94 , 96 , 100 , 103 , 104 , 107 , 110 ], and reported a decrease in hospital antibiotic procurement cost [ 65 , 71 , 81 , 90 , 93 , 94 ], savings in antibiotic costs [ 39 , 69 , 86 , 88 , 104 , 110 ], decrease in antibiotic therapy and antibiotic prophylaxis cost [ 67 , 107 ], and hospitalization costs [ 110 ].…”

Effects of a feedback intervention on antibiotic prescription control in primary care institutions based on depth graph neural network technology: a cluster randomized cross-over controlled trial

“…Feedback interventions are the act of providing knowledge of the results of a behavior or performance to an individual [31, 32]. Feedback interventions can change behavior and improve performance and outcomes [16, 33]. Physicians who entered the intervention group received 3 feedback measures, including a real-time warning pop-up message, a 10-day antibiotic prescription feedback, and distribution of educational brochures.…”