Abstract
BackgroundThe success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation.MethodsProspective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses.ResultsTime series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation.ConclusionsASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the effectiveness of ASPs in non-ICU settings.
Highlights
Antibiotic overuse has led to increasing rates of antibiotic resistant bacterial infections and antimicrobial-related adverse events, resulting in increased patient morbidity and mortality [1]
We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-Intensive Care Units (ICU) settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation
ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics
Summary
Antibiotic overuse has led to increasing rates of antibiotic resistant bacterial infections and antimicrobial-related adverse events, resulting in increased patient morbidity and mortality [1]. Of the studies evaluating total antibiotic use outside of the ICU, there was substantial variation in their ASP interventions and study designs [4,5,6,7,8]. These studies rarely used control groups, performed PAAF infrequently, had short follow-up, delayed PAAF until microbiological information was available, or targeted only specific antibiotics. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation
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