A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

Abstract

We evaluated the use of antimicrobials expressed as defined daily doses (DDDs) per 1,000 patient days and days of therapy (DOT) per 100 occupied bed-days in a intensive care unit (ICU) of a general hospital in Barcelona, Spain, before and after implementation of an antimicrobial stewardship (AMS) program (2007 to 2010 versus 2011 to 2015). The quarterly costs of antimicrobials used in the ICU and its weight in the overall hospital costs of antimicrobials were calculated. The effect of the applied AMS program on DDDs and DOT time series data was analyzed by means of intervention time series analysis. A total of 5,002 patients were included (1,971 for the first [before] period and 3,031 for the second [after] period). The percentage of patients treated with one or more antimicrobials decreased from 88.6 to 77.2% ( < 0.001). DDDs decreased from 246.8 to 192.3 (mean difference, -54.5; = 0.001) and DOT from 66.7 to 54.6 (mean difference, -12.1; = 0.066). The mean cost per trimester decreased from €115,543 to €73,477 (mean difference, -42,065.4 euros; < 0.001), and the percentage of ICU antimicrobials cost with respect to the total cost of hospital antimicrobials decreased from 28.5 to 22.8% (mean difference, -5.59; = 0.023). Implementation of an AMS program in the ICU was associated with a marked reduction in the use of antimicrobials, with cost savings close to one million euros since its implementation. An AMS program can have a significant impact on optimizing antimicrobial use in critical care practice.

Persepsi Dokter tentang Strategi Antimicrobial Stewardship Program di Sebuah Rumah Sakit Umum di Surabaya

“…Dengan kata lain, temuan peningkatan ketepatan penggunaan antibiotik pada beberapa penelitian dapat berupa hasil analisis terhadap penggunaan beberapa jenis antibiotik. Sangat dimungkinkan untuk menemukan data penggunaan jenis antibiotik tertentu yang tidak mengalami peningkatan ketepatan setelah implementasi ASP [6,23,24] Tema 3: persetujuan implementasi ASP yang bersyarat "Persetujuan yang bersyarat" yang dimaksud dalam penelitian ini adalah adanya tuntutan partisipan agar sumber daya (resources) penunjang dipenuhi terlebih dahulu sebelum implementasi ASP. Sumber daya yang secara spesifik diajukan oleh dokter dalam penelitian ini adalah keberadaan tim ASP.…”

Designing antimicrobial stewardship initiatives to enhance scientific dissemination

“…Again, supplementary data or an appendix could be utilized to include these details. In an interrupted time series study, autoregressive integrated moving average (ARIMA) analysis may be used to control for variability and forecast future variability in the outcome of interest over time, as utilized by Álvarez‐Lerma et al in a study of ICU antimicrobial consumption before and after AMS program implementation . Working with a biostatistician prior to, during, and post study is prudent when considering use of these advanced statistical analyses.…”

Effect of critical care pharmacist on antibiotic medication optimizations, reduce drug costs but not increase mortality: A retrospective cohort study in the real world research

“…In recent years, several studies improved the positive in uence of clinical pharmacists on the health care of patients with chronic diseases such as cardiovascular diseases, diabetes and anticoagulant therapy [5][6][7]. Care of the critical patients has become a multidiscipline [8] and antimicrobial stewardship (AMS) programs have been developed for optimizing the treatment of infections, to reduce infection-related morbidity and mortality [9,10]. Participation of a critical care pharmacist resulted in the identi cation and treatment of multiple medication-related problems [11], which improved clinical and economic outcomes [8,[12][13][14].…”