Tali Shafat1,2,3, Orly Shimoni2,4, Anna Nikonov4, Lior Nesher5,6. 1. Infectious Disease Institute, Soroka University Medical Center, Beer Sheba, Israel. 2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel. 3. Clinical Research Center, Soroka University Medical Center, Beer Sheba, Israel. 4. Pharmacy Services, Soroka University Medical Center, Beer Sheba, Israel. 5. Infectious Disease Institute, Soroka University Medical Center, Beer Sheba, Israel. nesherke@bgu.ac.il. 6. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel. nesherke@bgu.ac.il.
Abstract
INTRODUCTION: Little is known about the kinetics and different phases of a successful antibiotic stewardship program (ASP) intervention. METHODS: We analyzed the trends of quarterly antibiotic use measured in defined daily dose (DDD)/100 days hospitalization using the Joinpoint Regression Program and interrupted time series analysis to objectively identify shifts in the trends of antibiotic use. We correlated these changes in trends with the introduction of a hospital-wide ASP intervention. RESULTS: The ASP intervention reduced the overall antibiotic use by 33%, from a prior steady state of 76.5 DDD/100 days hospitalization to a post-intervention steady state of 51.2 DDD/100 days hospitalization (p < 0.001). We identified four distinct phases in the trends: prior steady state (A), early intervention (B), accelerated phase (C), and post steady state (D). From A to B a change of slope (-1.46) [SE 0.37, 95% CI -2.23, -0.69 (p = 0.002)]; B to C, a further decrease of slope (-4.70) [SE 0.64, 95% CI -6.03, -3.37 (p = 0.001)]; between periods C and D, straightening out of the slope (+ 6.84) [SE 0.55, 95% CI 5.70, 7.98 (p < 0.001)] to a new post-intervention steady state. It took 1.5 years after completion of the intervention to reach the new steady state. CONCLUSIONS: We demonstrate that ASP interventions require time to achieve the maximal effect. Successful interventions require physicians to adapt new prescribing behaviors and gain confidence in the change; this adaptation can be a prolonged process and might even take years after the introduction of the ASP. These factors should be considered when planning and implementing ASP interventions.
INTRODUCTION: Little is known about the kinetics and different phases of a successful antibiotic stewardship program (ASP) intervention. METHODS: We analyzed the trends of quarterly antibiotic use measured in defined daily dose (DDD)/100 days hospitalization using the Joinpoint Regression Program and interrupted time series analysis to objectively identify shifts in the trends of antibiotic use. We correlated these changes in trends with the introduction of a hospital-wide ASP intervention. RESULTS: The ASP intervention reduced the overall antibiotic use by 33%, from a prior steady state of 76.5 DDD/100 days hospitalization to a post-intervention steady state of 51.2 DDD/100 days hospitalization (p < 0.001). We identified four distinct phases in the trends: prior steady state (A), early intervention (B), accelerated phase (C), and post steady state (D). From A to B a change of slope (-1.46) [SE 0.37, 95% CI -2.23, -0.69 (p = 0.002)]; B to C, a further decrease of slope (-4.70) [SE 0.64, 95% CI -6.03, -3.37 (p = 0.001)]; between periods C and D, straightening out of the slope (+ 6.84) [SE 0.55, 95% CI 5.70, 7.98 (p < 0.001)] to a new post-intervention steady state. It took 1.5 years after completion of the intervention to reach the new steady state. CONCLUSIONS: We demonstrate that ASP interventions require time to achieve the maximal effect. Successful interventions require physicians to adapt new prescribing behaviors and gain confidence in the change; this adaptation can be a prolonged process and might even take years after the introduction of the ASP. These factors should be considered when planning and implementing ASP interventions.
Authors: Pranita D Tamma; Edina Avdic; John F Keenan; Yuan Zhao; Gobind Anand; James Cooper; Rebecca Dezube; Steven Hsu; Sara E Cosgrove Journal: Clin Infect Dis Date: 2017-03-01 Impact factor: 9.079
Authors: Tamar F Barlam; Sara E Cosgrove; Lilian M Abbo; Conan MacDougall; Audrey N Schuetz; Edward J Septimus; Arjun Srinivasan; Timothy H Dellit; Yngve T Falck-Ytter; Neil O Fishman; Cindy W Hamilton; Timothy C Jenkins; Pamela A Lipsett; Preeti N Malani; Larissa S May; Gregory J Moran; Melinda M Neuhauser; Jason G Newland; Christopher A Ohl; Matthew H Samore; Susan K Seo; Kavita K Trivedi Journal: Clin Infect Dis Date: 2016-04-13 Impact factor: 9.079
Authors: Emelie C Schuts; Marlies E J L Hulscher; Johan W Mouton; Cees M Verduin; James W T Cohen Stuart; Hans W P M Overdiek; Paul D van der Linden; Stephanie Natsch; Cees M P M Hertogh; Tom F W Wolfs; Jeroen A Schouten; Bart Jan Kullberg; Jan M Prins Journal: Lancet Infect Dis Date: 2016-03-03 Impact factor: 25.071
Authors: Timothy C Jenkins; Bryan C Knepper; Allison L Sabel; Ellen E Sarcone; Jeremy A Long; Jason S Haukoos; Steven J Morgan; Walter L Biffl; Andrew W Steele; Connie S Price; Philip S Mehler; William J Burman Journal: Arch Intern Med Date: 2011-02-28
Authors: Peter Davey; Charis A Marwick; Claire L Scott; Esmita Charani; Kirsty McNeil; Erwin Brown; Ian M Gould; Craig R Ramsay; Susan Michie Journal: Cochrane Database Syst Rev Date: 2017-02-09
Authors: Evelina Tacconelli; Maria A Cataldo; M Paul; L Leibovici; Jan Kluytmans; Wiebke Schröder; Federico Foschi; Giulia De Angelis; Chiara De Waure; Chiara Cadeddu; Nico T Mutters; Petra Gastmeier; Barry Cookson Journal: BMJ Open Date: 2016-02-19 Impact factor: 2.692