Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram

bThe implementation of antimicrobial stewardship programs (ASPs) is a promising strategy to help address the problem of antimicrobial resistance. We sought to determine the efficacy of ASPs and their effect on clinical and economic parameters. We searched PubMed, EMBASE, and Google Scholar looking for studies on the efficacy of ASPs in hospitals. Based on 26 studies (extracted from 24,917 citations) with pre-and postimplementation periods from 6 months to 3 years, the pooled percentage change of total antimicrobial consumption after the implementation of ASPs was ؊19.1% (95% confidence interval [CI] ‫؍‬ ؊30.1 to ؊7.5), and the use of restricted antimicrobial agents decreased by ؊26.6% (95% CI ‫؍‬ ؊52.3 to ؊0.8). Interestingly, in intensive care units, the decrease in antimicrobial consumption was ؊39.5% (95% CI ‫؍‬ ؊72.5 to ؊6.4). ). Hospital ASPs result in significant decreases in antimicrobial consumption and cost, and the benefit is higher in the critical care setting. Infections due to specific antimicrobial-resistant pathogens and the overall hospital length of stay are improved as well. Future studies should focus on the sustainability of these outcomes and evaluate potential beneficial long-term effects of ASPs in mortality and infection rates.A bout one-third of the hospitalized patients and more than two-thirds of critically ill patients are on antimicrobial therapy at any time (1, 2), and up to half of antibiotic prescriptions are inappropriate or not necessary (3). In 2013, the Centers for Disease Control and Prevention (CDC) reported that about 2 million patients are infected yearly with antimicrobialresistant organisms in the United States, and about 23,000 deaths are directly attributed to these infections (3). This resulted in a call to action for acute care hospitals to implement antimicrobial stewardship programs (ASPs) (4, 5), a term that is used to describe the integrated strategy of improving antimicrobial use in order to enhance patient outcomes, reduce antimicrobial cost, and minimize the side effects associated with antimicrobial use, including drug resistance and nosocomial infections (4, 6, 7). Although there are studies that have already presented data on the efficacy of ASPs in the inpatient setting (8-10), limitations compromise their generalization (i.e., the studies were only conducted in the United States [8], age and study design limitations [9], a lack of clinical outcomes [10], etc.). The purpose of our systematic review and meta-analysis was to measure the efficacy of the implementation of an ASP expressed in daily defined doses (DDD) per 1,000 patient days in the hospital setting independently of the age and study design and to assess the subsequent clinical and economic outcomes. MATERIALS AND METHODSThis systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol (11).Search strategy. A systematic electronic search of PubMed, EMBASE, and Google Scholar databases was performed for pertinent studies up t...

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“…S1 in the supplemental material). Of note, only one of six studies applied antifungal restriction in their formulary (Table 1) (30).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Karanika

Paudel

Grigoras

et al. 2016

Antimicrob Agents Chemother

308

192

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“…19 Studies of the effect of reducing antimicrobial use on the incidence of antimicrobial resistance have yielded various results. 12,14,20 In 1990, Mouton et al 21 reported a correlation of methicillin resistance in coagulase-negative staphylococci and use of (flu)cloxacillin, cephalosporins and gentamicin. Other studies have reported correlations in use of antimicrobials and development of resistance in S. aureus.…”

Section: Discussionmentioning

confidence: 99%

Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections

et al. 2012

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We analyzed the effect of antimicrobial use and implementation of a hand hygiene program on the incidence of healthcareassociated infections (HAIs) and healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections at the Chung Shan Medical University Hospital (Taichung, Taiwan). Monthly data were retrospectively reviewed from January 2004 to December 2010. Use of antimicrobials and alcohol-based hand cleaner were separately regressed against the incidences of HAIs and HA-MRSA infections. Infection incidence was expressed as persons per 1000 patient days (PDs), monthly use of i.v. antibiotics was expressed as defined daily doses per 1000 PDs and monthly alcohol-based hand cleaner use was expressed as bottle per 1000 PDs. Multivariate analysis indicated that use of hand cleaner was associated with reduced incidence of HAIs (P ¼ 0.0001) and HA-MRSA infections (Po0.0001). Time-series analysis indicated that increased use of hand cleaner was significantly associated with significant decreases in the incidences of HAIs and HA-MRSA infections. Total antibiotic use had no significant effect on HAIs, but was associated with more HA-MRSA infections. In addition, the use of J01CR01 antibiotics (combinations of penicillins, including b-lactamase inhibitors) in particular was correlated with significantly increased incidence of HA-MRSA infections. Our forecasting model demonstrates the efficacy of a hand hygiene program and the need to limit the use of certain restricted antimicrobials in order to reduce the incidence of HAIs and HA-MRSA infections.

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“…At a 731-bed teaching hospital in North Carolina, a program incorporating restriction and review was implemented (33). Restricted antimicrobials required prior approval by an infectious diseases physician, whereas controlled agents were freely dispensed but reviewed within 48 h by a clinical pharmacist.…”

Section: Review and Feedback Strategiesmentioning

confidence: 99%

Antimicrobial Stewardship Programs in Health Care Systems

2005

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SUMMARY Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources.

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Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram

Cited by 104 publications

References 21 publications

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections

Antimicrobial Stewardship Programs in Health Care Systems

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