Efficacy of a Postprescription Review of Broad-Spectrum Antimicrobial Agents With Feedback: A 4-Year Experience of Antimicrobial Stewardship at a Tertiary Care Center

Abstract

BackgroundAn inpatient antimicrobial stewardship program is vital for judicious antimicrobial use. We began a hospital-wide, postprescription review with feedback (PPRF) in 2014; the present study evaluated its impact on antimicrobial consumption and clinical outcomes over 4 years.MethodsOnce-weekly PPRF for carbapenems and piperacillin/tazobactam was implemented. We tracked the data on each antimicrobial use as days of therapy (DOT) per 1000 patient-days (PD). Changes in the incidence of drug-resistant organisms, in-hospital mortality, and length of hospital stay per month were analyzed by an interrupted time series.ResultsCarbapenem use continued to decline in the preintervention and intervention periods (−0.73 and −0.003 DOT/1000 PD, respectively), and although monthly average use remained low in the intervention period (8.3 DOT/1000 PD), more importantly, the postintervention change in the slope diminished significantly. Piperacillin/tazobactam use showed a steeper decline in the intervention period, but the change in the slope was not statistically significant (change in slope: −0.20 DOT/1000 PD per month [P = .16]). Postintervention use of narrower-spectrum antimicrobials including ampicillin/sulbactam (change in slope: +0.58 DOT/1000 PD per month [P < .001]) increased. The antimicrobial cost and the monthly average length of hospital stay also declined (−37.4 USD/1000 PD per month [P < .001] and −0.04 days per month [P < .001], respectively), whereas few postintervention changes in the incidence of drug-resistant organisms were observed.ConclusionsIn our study, the 4-year PPRF for broad-spectrum antimicrobials coincided with a reduction in the use of targeted antimicrobials and resulted in an improvement in 1 patient-centered outcome, thus conferring the additional benefit of reducing expenditures for antimicrobials.

Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study

“…Before its implementation, there was no form of antimicrobial stewardship except for an infectious disease (ID) consultation service, which was begun in July 2013 by a physician with American Board of Internal Medicine Infectious Diseases certification [ 15 ]. Details of the PPRF intervention at the study institution have been described elsewhere [ 9 ]. A clinical pharmacist routinely monitored all inpatient antimicrobial consumption, and all hospital wards were included in the PPRF intervention.…”

Impact of implementing a non-restrictive antibiotic stewardship program in an emergency department: a four-year quasi-experimental prospective study

“…The positive impact of ASPs on reducing the antibiotic use has been widely assessed in several inpatient settings [20][21][22] . However, very little literature is available for the ED.…”

Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

“…Although PPRF is a well-established intervention, there are few resource-rich Japanese hospitals implementing early PPRF against overall antimicrobial use for 48-72 hours. Therefore, we must make a practical plan to implement the stewardship according to available institutional resources: e.g., focusing on broadspectrum antimicrobials and/or longer duration of use, and providing once-weekly intervention [16][17][18][19].…”