Impact of restriction policy as part of an antimicrobial stewardship program in a university hospital of a developing country

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Background: In an era of growing concern about bacterial resistance and hospital costs, limiting the use of broad spectrum antibiotics is important. The purpose of this study is to evaluate the impact of restriction policy as part of an antimicrobial stewardship program. Methods: The study was conducted in a 140-bed university hospital of a developing country. Tools of the program were development of guidelines of antimicrobial therapy for common community and hospital-acquired infections and education to improve antimicrobial prescription. During the first period of the program we implemented a policy of prior approval for selected antibiotics. Every day pharmacists reviewed prescriptions and the team discussed with prescribing physicians to accomplish with hospital guidelines. After one year of implementation of the program, we stopped the restriction policy and we kept on working with the other tools of the program. To assess if cessation of restriction was associated with an increase in antimicrobial consumption, we measured antibiotic consumption during the first year (period 1) and during one year after we stopped restriction (period 2). Antimicrobial consumption was measured by Defined Daily Dose (DDD) normalized by 1000 bed-days. Results: During the period 2 antibiotic consumption of ceftriaxone, ceftazidime and vancomycin decreased; it remained unchanged for piperacillin-tazobactam while cefepime, imipenem and colsitin increasedTabled 1Period 1Period 2Percentage of Increase/Decrease (%)P valueAntibioticDDD per 1000 beddaysCefepime53,7380,97+50,7<0.01Ceftazidime17,5612,57-28,4<0.01Ceftriaxone40,0032,07-19,8<0,01Colistin9,2519,50+110,8<0,01Imipenem14,1121,65+53,4<0,01Piperacillintazobactam30,3630,19-0,050,9Vancomycin44,3136,98-16,5<0,01 Open table in a new tab Conclusion: Antibiotic consumption of 4 out of 7 agents did not increased after we stopped restriction policy, while some agents suffered an increased; these agents were those mainly prescribed in intensive care unit associated to an increase in isolation of multidrug resistant Acinetobacter sp. Programs aimed to improve antibiotic prescription accompanied by measurement of antibiotic consumption may help to focus the program in some particular agents and areas of the hospital, and also to reinforce other infection control measures. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive