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.
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.
Authors: M T Baysari; K Oliver; B Egan; L Li; K Richardson; I Sandaradura; J I Westbrook; R O Day Journal: Appl Clin Inform Date: 2013-12-11 Impact factor: 2.342
Authors: Eduardo Casaroto; Alexandre R Marra; Thiago Zinsly Sampaio Camargo; Ana Rita Araújo de Souza; Carlos Eduardo Saldanha de Almeida; Elizia Piassi Pedroti; Elivane da Silva Victor; Oscar Fernando Pavão dos Santos; Michael B Edmond; Alexandre Holthausen Campos Journal: BMC Infect Dis Date: 2015-06-30 Impact factor: 3.090