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Prescribing trends before and after implementation of an antimicrobial stewardship program.
Med J Aust. 2013 Mar 18;198(5):262-6
Authors: Cairns KA, Jenney AW, Abbott IJ, Skinner MJ, Doyle JS, Dooley M, Cheng AC
Abstract
OBJECTIVES: Antimicrobial stewardship programs are recommended to reduce antimicrobial resistance by reducing inappropriate use of antimicrobials. We implemented an antimicrobial stewardship program and aimed to evaluate its effect on broad-spectrum antimicrobial use.
DESIGN, SETTING AND PARTICIPANTS: Observational study with historical control using interrupted time series analysis conducted in a tertiary referral hospital. Hospital inpatients prescribed restricted antimicrobials for non-standard indications, where approval had expired or without approval.
INTERVENTION: Baseline period of 30 months immediately followed by an 18-03 intervention period commencing January 2011.
MAIN OUTCOME MEASURES: Number and type of interventions made by antimicrobial stewardship team; monthly rate of use of broad-spectrum antimicrobial agents (in defined daily doses/1000 occupied bed-18s).
RESULTS: The antimicrobial stewardship team made 1104 recommendations in 779 patients during the 18-03 intervention period. In 64% of cases, the recommendation was made to cease or de-escalate the antimicrobial therapy, or to change from intravenous to oral therapy. The introduction of the intervention resulted in an immediate 17% (95% CI, 13%-20%) reduction in broad-spectrum antimicrobial use in the intensive care unit and a 10% (95% CI, 4%-16%) reduction in broad-spectrum antimicrobial use outside the intensive care unit. Reductions were particularly seen in cephalosporin and glycopeptide use, although these were partially offset by increases in the use of β-lactam-β-lactamase inhibitors.
CONCLUSIONS: The introduction of an antimicrobial stewardship program, including postprescription review, resulted in an immediate reduction in broad-spectrum antimicrobial use in a tertiary referral centre. However, the effect of this intervention reduced over time.
PMID: 23496402 [PubMed - indexed for MEDLINE]