How Does Antimicrobial Stewardship Affect Inappropriate Antibiotic Therapy in Urological Patients?

Abstract

Antimicrobial stewardship teams (ASTs) have been well-accepted in recent years; however, their clinical outcomes have not been fully investigated in urological patients. The purpose of this study was to evaluate the outcomes of intervention via a retrospective review of urological patients, as discussed in the AST meetings, who were treated with broad-spectrum antibiotics between 2014 and 2018 at the Department of Urology, Kobe University Hospital in Japan. Interventions were discussed in AST meetings for patients identified by pharmacists as having received inappropriate antibiotic therapy. The annual changes in numbers of inappropriate medications and culture submissions over five years at the urology department were statistically analyzed. Among 1,033 patients audited by pharmacists, inappropriate antibiotic therapy was found in 118 cases (11.4%). The numbers of inappropriate antibiotic use cases and of interventions for indefinite infections had significantly decreased during the study period (p = 0.012 and p = 0.033, respectively). However, the number of blood and drainage culture submissions had significantly increased (p = 0.009 and p = 0.035, respectively). Our findings suggest that urologists have probably become more familiar with infectious disease management through AST intervention, leading to a decrease in inappropriate antibiotic use and an increase in culture submissions.

Retrospective Observational Study of Risk Factors for Febrile Infectious Complications after Urodynamic Studies in Patients with Suspected Neurogenic Lower Urinary Tract Disturbance

“…Patients who had UTI or urogenital infection with fever and bacteriuria or pyuria within 7 days after UDS with no apparent other infectious diseases were defined as having post-UDS infection [6]. The definition of UTI or urogenital infection was symptomatic with pyuria (≥5 white blood cells [WBCs]/high-power field [hpf]) and bacteriuria.…”

“…However, the Antimicrobial resistance action plan suggests avoiding unnecessary antimicrobial use of fluoroquinolones, 3rd-generation cephalosporins, and tetracycline [5]. Considering both suggestions, many researchers have considered how to decrease antimicrobial use according to recommendations based on their hospital antimicrobial stewardship program [6].…”

Risk Factors for the Acquisition of Enterococcus faecium Infection and Mortality in Patients with Enterococcal Bacteremia: A 5-Year Retrospective Analysis in a Tertiary Care University Hospital

“…Overuse of broad-spectrum antibiotics leads to the selective growth of resistant bacteria; thus, one of the aims of antimicrobial stewardship is to promote appropriate antibiotic use. Our hospital has practiced antimicrobial stewardship since 2010 to optimize antibiotic usage [ 27 , 28 , 29 ]; however, the consumption of antipseudomonal penicillins significantly increased between 2009 and 2016 [ 27 ]. Thus, narrower spectrum antibiotics should be prescribed to avoid the development and prevalence of bacterial resistance as much as possible with consideration to preexisting infectious diseases and patient conditions even before the onset of bacteremia.…”

Effect of Antimicrobial Stewardship on Oral Quinolone Use and Resistance Patterns over 8 Years (2013–2020)

“…To assess changes due to COVID-19 in the number of prescriptions, we compared the data between 2019 and 2020; however, the impact of COVID-19 on the results from 2020 could not be sufficiently investigated. Lastly, we implemented other ASPs, such as audit and feedback programs to promote appropriate intravenous antibiotic use [ 13 , 34 ], and educational interventions to optimize oral third-cephalosporin use during the investigation period [ 15 , 18 ]. Therefore, we may not have fully evaluated the effects of our educational interventions to promote appropriate oral quinolone use.…”