Abstract
Background: Implementing a successful antimicrobial stewardship program (ASP) is difficult for non-academic community (NAC) hospitals due to insufficient infrastructure. Aim: We evaluated the impact of an infectious disease specialist (IDS) on implementing an ASP in a resource-limited setting in Korea. Methods: A retrospective study was performed at a NAC hospital between June 2015 and August 2018. An IDS has led an ASP at the hospital since June 2017. We used an interrupted time series analysis to evaluate longitudinal effects of the IDS-led ASP on the amount of antibiotic use and incidence of multidrug-resistant organism (MDRO) acquisition. Findings: Total antibiotic use changed from 698.82 ± 74.41 to 602.09 ± 69.94 defined daily dose/1000 patient-days (PDs) after intervention. An immediate reduction in the use of carbapenems, glycopeptides, penicillins, and other antibiotics followed the IDS-led ASP. The 3rd/4th generation cephalosporins and carbapenems prescription rates decreased in slope after the intervention. Incidence of MDRO acquisition changed from 1.38, 0.78, and 0.21/1000 PDs to 1.06, 0.15, and 0.32/1000 PDs in methicillin-resistant Staphylococcus aureus, multidrug-resistant Acinetobacter baumannii, and multidrug-resistant Pseudomonas aeruginosa, respectively. The incidence of methicillin-resistant Staphylococcus aureus and multidrug-resistant Acinetobacter baumannii acquisition immediately decreased following intervention. Conclusion: An IDS can implement a successful ASP by reducing antibiotic consumption and MDRO acquisition at resource-limited NAC hospitals.
Highlights
Use of antimicrobial agents has reduced mortality in infectious diseases
Between June 2016 and August 2018, the most prevalent organism reported in clinical specimens was methicillin-resistant Staphylococcus aureus (MRSA) (n = 362), followed by multidrug-resistant Acinetobacter baumannii (MDRAB) (n = 139) and multidrug-resistant Pseudomonas aeruginosa (MDRPA) (n = 77) (Table 1)
A large proportion of patients in non-academic community (NAC) hospitals come from long-term care facilities; they are likely to suffer from recurrent aspiration pneumonia or severe decubitus ulcers, which result in an increased chance of antibiotic use [21]
Summary
Use of antimicrobial agents has reduced mortality in infectious diseases. excessive antibiotic use has caused development of antimicrobial resistance (AMR) in bacteria [1,2]. The importance of the role of an infectious disease specialist (IDS) in implementing a successful ASP has been proven through previous studies [8,9,10]. Most of these studies evaluated the role of an IDS and the effects of an ASP in large, academic hospitals. We used an interrupted time series analysis to evaluate longitudinal effects of the IDS-led ASP on the amount of antibiotic use and incidence of multidrug-resistant organism (MDRO) acquisition. Conclusion: An IDS can implement a successful ASP by reducing antibiotic consumption and MDRO acquisition at resource-limited NAC hospitals
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