Journal article
Efficacy of a Postprescription Review of Broad-Spectrum Antimicrobial Agents With Feedback: A 4-Year Experience of Antimicrobial Stewardship at a Tertiary Care Center
Open forum infectious diseases, Vol.5(12), p.ofy314
12/01/2018
DOI: 10.1093/ofid/ofy314
PMCID: PMC6289023
PMID: 30555853
Abstract
Background. An inpatient antimicrobial stewardship program is vital for judicious antimicrobial use. We began a hospital-wide, postprescription review with feedback (PPRF) in 2014; the present study evaluated its impact on antimicrobial consumption and clinical outcomes over 4 years.
Methods. Once-weekly PPRF for carbapenems and piperacillin/tazobactam was implemented. We tracked the data on each antimicrobial use as days of therapy (DOT) per 1000 patient-days (PD). Changes in the incidence of drug-resistant organisms, in-hospital mortality, and length of hospital stay per month were analyzed by an interrupted time series.
Results. Carbapenem use continued to decline in the preintervention and intervention periods (-0.73 and -0.003 DOT/1000 PD, respectively), and although monthly average use remained low in the intervention period (8.3 DOT/1000 PD), more importantly, the postintervention change in the slope diminished significantly. Piperacillin/tazobactam use showed a steeper decline in the intervention period, but the change in the slope was not statistically significant (change in slope: -0.20 DOT/1000 PD per month [P =.16]). Postintervention use of narrower-spectrum antimicrobials including ampicillin/sulbactam (change in slope: +0.58 DOT/1000 PD per month [P <.001]) increased.
The antimicrobial cost and the monthly average length of hospital stay also declined (-37.4 USD/1000 PD per month [P <.001] and -0.04 days per month [P <.001], respectively), whereas few postintervention changes in the incidence of drug-resistant organisms were observed.
Conclusions. In our study, the 4-year PPRF for broad-spectrum antimicrobials coincided with a reduction in the use of targeted antimicrobials and resulted in an improvement in 1 patient-centered outcome, thus conferring the additional benefit of reducing expenditures for antimicrobials.
Details
- Title: Subtitle
- Efficacy of a Postprescription Review of Broad-Spectrum Antimicrobial Agents With Feedback: A 4-Year Experience of Antimicrobial Stewardship at a Tertiary Care Center
- Creators
- Hitoshi Honda - Tokyo Metropolitan Tama Medical CenterShutaro Murakami - Tokyo Metropolitan Tama Medical CenterYasuaki Tagashira - Tokyo Metropolitan Tama Medical CenterYuki Uenoyama - Tokyo Metropolitan Tama Medical CenterKaoru Goto - Tokyo Metropolitan Tama Medical CenterAkane Takamatsu - Tokyo Metropolitan Tama Medical CenterShinya Hasegawa - Tokyo Metropolitan Tama Medical CenterYasuharu Tokuda - Teaching Hosp, Muribushi Project, Okinawa, Japan
- Resource Type
- Journal article
- Publication Details
- Open forum infectious diseases, Vol.5(12), p.ofy314
- DOI
- 10.1093/ofid/ofy314
- PMID
- 30555853
- PMCID
- PMC6289023
- NLM abbreviation
- Open Forum Infect Dis
- ISSN
- 2328-8957
- eISSN
- 2328-8957
- Publisher
- Oxford Univ Press
- Number of pages
- 8
- Grant note
- 16K09196 / Japan Society for the Promotion of Science (JSPS); Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT); Japan Society for the Promotion of Science 16K09196 / Grants-in-Aid for Scientific Research; Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT); Japan Society for the Promotion of Science; Grants-in-Aid for Scientific Research (KAKENHI)
- Language
- English
- Date published
- 12/01/2018
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985177945102771
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