Stefan Schröder1, Marie-Kathrin Klein2,3, Bernhard Heising3, Sebastian W Lemmen4. 1. Department of Anesthesiology and Intensive Care Medicine, Düren Hospital, Roonstraße 30, 52351, Düren, Germany. stefan.schroeder@krankenhaus-dueren.de. 2. Department of Anesthesiology and Intensive Care Medicine, Düren Hospital, Roonstraße 30, 52351, Düren, Germany. 3. Department of Infection Control and Infectious Diseases, Düren Hospital, Roonstraße 30, 52351 Düren, Germany. 4. Department of Infection Control and Infectious Diseases, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074 Aachen, Germany.
Abstract
OBJECTIVE: This retrospective observational study examined the implementation of antibiotic stewardship (ABS) on the surgical intensive care unit (SICU) of a specialized academic teaching hospital. METHODS: Application density of antimicrobial agents (ADA), substance class change, development of resistance, and clinical outcomes were investigated with reference to ABS in three intervals over a 10-year period: the pre-intervention phase (2008-2010), the intervention phase (2011-2014), and the post-intervention phase (2015-2017). RESULTS: Following the introduction of ABS, ADA was reduced from 89.3 recommended daily doses/100 patient days (RDD/100 PD) at the pre-intervention phase to 68.0 RDD/100 PD at the post-intervention phase. The antibiotic ADA (AB-ADA) similarly showed a significant decrease from 83.3 to 62.0 RDD/100 PD (p < 0.0001). The case mix index (CMI), which describes the average case severity across patients and mortality on the SICU was not significantly different comparing intervention and post-intervention phase. It was also possible to achieve a substance class change following the introduction of ABS. There was no obvious change in bacterial resistance rates. CONCLUSION: The study demonstrates a sustainable effect of the implementation of ABS, which was sustained through the post-intervention phase.
OBJECTIVE: This retrospective observational study examined the implementation of antibiotic stewardship (ABS) on the surgical intensive care unit (SICU) of a specialized academic teaching hospital. METHODS: Application density of antimicrobial agents (ADA), substance class change, development of resistance, and clinical outcomes were investigated with reference to ABS in three intervals over a 10-year period: the pre-intervention phase (2008-2010), the intervention phase (2011-2014), and the post-intervention phase (2015-2017). RESULTS: Following the introduction of ABS, ADA was reduced from 89.3 recommended daily doses/100 patient days (RDD/100 PD) at the pre-intervention phase to 68.0 RDD/100 PD at the post-intervention phase. The antibiotic ADA (AB-ADA) similarly showed a significant decrease from 83.3 to 62.0 RDD/100 PD (p < 0.0001). The case mix index (CMI), which describes the average case severity across patients and mortality on the SICU was not significantly different comparing intervention and post-intervention phase. It was also possible to achieve a substance class change following the introduction of ABS. There was no obvious change in bacterial resistance rates. CONCLUSION: The study demonstrates a sustainable effect of the implementation of ABS, which was sustained through the post-intervention phase.
Entities:
Keywords:
Antibiotic stewardship; Antimicrobial agents; Intensive care medicine; Outcome; Sustainability
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