Takashi Matono1, Yuichi Umeda2, Moritsugu Uchida2, Hidenobu Koga3, Naoya Kanatani4, Yoshimi Furuno4, Tomonori Yamashita5, Kenichi Nakamura6. 1. Department of Infectious Diseases, Aso Iizuka Hospital, Fukuoka, Japan; Clinical Research Support Office, Aso Iizuka Hospital, Fukuoka, Japan; Infection Control Center, Aso Iizuka Hospital, Fukuoka, Japan. Electronic address: tmatonoh1@aih-net.com. 2. Department of Pharmacy, Aso Iizuka Hospital, Fukuoka, Japan; Infection Control Center, Aso Iizuka Hospital, Fukuoka, Japan. 3. Clinical Research Support Office, Aso Iizuka Hospital, Fukuoka, Japan. 4. Department of Clinical Laboratory, Aso Iizuka Hospital, Fukuoka, Japan; Infection Control Center, Aso Iizuka Hospital, Fukuoka, Japan. 5. Infection Control Center, Aso Iizuka Hospital, Fukuoka, Japan. 6. Infection Control Center, Aso Iizuka Hospital, Fukuoka, Japan; Department of General Internal Medicine, Aso Iizuka Hospital, Fukuoka, Japan.
Abstract
INTRODUCTION: There is an insufficient number of infectious disease (ID) physicians in Japan. Hence, we considered a strategy to implement antimicrobial stewardship under these resource-limited settings. METHODS: We compared carbapenem consumption, measured as days of therapy per 100 patient-days, between 24-month baseline and 12-month intervention periods. During the intervention period, an ID physician provided daily advises to prescribers against prolonged carbapenem use (≥14 days). Additionally, we sent all doctors a table containing the weekly point prevalence aggregate of carbapenem use of each department for 7-13 and ≥ 14 days via e-mail. RESULTS: Among the 1241 carbapenem courses during the intervention period, the ID physician provided a total of 96 instances of feedback regarding carbapenem use for ≥14 days, with an acceptance rate of 76%. After the initiation of the intervention, the trend in monthly carbapenem consumption changed (coefficient: -0.62; 95% CI: -1.15 to -0.087, p = 0.024), and its consumption decreased (coefficient: -0.098; 95% CI: -0.16 to -0.039, p = 0.002) without an increase in the consumption of broad-spectrum antimicrobials or in-hospital mortality. Interestingly, the monthly number of carbapenem courses, but not the duration of carbapenem use, significantly decreased (coefficient: -3.02; 95% CI: -4.63 to -1.42, p = 0.001). The carbapenem-related annual estimated savings after the intervention was $83,745, with a 22% cost reduction. CONCLUSIONS: Our ID physician-led daily intervention with weekly feedback regarding long-term carbapenem use was effective in reducing antimicrobial consumption. Such feedback may be useful in changing the prescribing behavior and promoting appropriate antimicrobial usage even in resource-limited settings.
INTRODUCTION: There is an insufficient number of infectious disease (ID) physicians in Japan. Hence, we considered a strategy to implement antimicrobial stewardship under these resource-limited settings. METHODS: We compared carbapenem consumption, measured as days of therapy per 100 patient-days, between 24-month baseline and 12-month intervention periods. During the intervention period, an ID physician provided daily advises to prescribers against prolonged carbapenem use (≥14 days). Additionally, we sent all doctors a table containing the weekly point prevalence aggregate of carbapenem use of each department for 7-13 and ≥ 14 days via e-mail. RESULTS: Among the 1241 carbapenem courses during the intervention period, the ID physician provided a total of 96 instances of feedback regarding carbapenem use for ≥14 days, with an acceptance rate of 76%. After the initiation of the intervention, the trend in monthly carbapenem consumption changed (coefficient: -0.62; 95% CI: -1.15 to -0.087, p = 0.024), and its consumption decreased (coefficient: -0.098; 95% CI: -0.16 to -0.039, p = 0.002) without an increase in the consumption of broad-spectrum antimicrobials or in-hospital mortality. Interestingly, the monthly number of carbapenem courses, but not the duration of carbapenem use, significantly decreased (coefficient: -3.02; 95% CI: -4.63 to -1.42, p = 0.001). The carbapenem-related annual estimated savings after the intervention was $83,745, with a 22% cost reduction. CONCLUSIONS: Our ID physician-led daily intervention with weekly feedback regarding long-term carbapenem use was effective in reducing antimicrobial consumption. Such feedback may be useful in changing the prescribing behavior and promoting appropriate antimicrobial usage even in resource-limited settings.
Authors: Khezar Hayat; Zia Ul Mustafa; Muhammad Nabeel Ikram; Muhammad Ijaz-Ul-Haq; Irum Noor; Muhammad Fawad Rasool; Hafiz Muhammad Ishaq; Anees Ur Rehman; Syed Shahzad Hasan; Yu Fang Journal: Front Pharmacol Date: 2022-01-04 Impact factor: 5.810