Abstract
BackgroundTo prevent antimicrobial resistance, both antimicrobial stewardship (AMS) and antifungal stewardship (AFS) in inpatient settings are needed in small/middle-sized hospitals as well as large hospitals.MethodsWe conducted the web-based, self-administered, nationwide cross-sectional study regarding AMS and AFS in inpatient settings in Japan, targeting hospitals that participated in a hospital epidemiology workshop conducted in July 2018. The questionnaire was composed of intervention protocols for use of broad-spectrum antimicrobials and antifungals within 7 or 28 d of beginning usage. These broad-spectrum antimicrobial and antifungal protocols were compared between large (≥501beds) and small/middle-sized (≤500 beds) hospitals.ResultsOf 240 hospitals surveyed, 39 (16%; 18 large and 21 small/middle-sized) responded. The number of hospitals that intervened in the use of broad-spectrum antimicrobials within 7 and 28 d were 17 (44%) and 34 (87%), respectively; those that intervened for antifungals were 3 (8%) and 10 (26%), respectively. Interventions for use of broad-spectrum antimicrobials within 7 d were significantly more frequent in small/middle-sized hospitals compared to large hospitals [13 (61. 9%) vs. 4 (22. 2%), odds ratio = 5.7, 95% confidence interval = 1.4–23.3, p = 0.023].ConclusionsSmall/middle-sized hospitals had more frequent interventions within 7 d of broad-spectrum antimicrobial use than large hospitals. More effort to improve AFS is needed among all hospitals.
Highlights
To prevent antimicrobial resistance, both antimicrobial stewardship (AMS) and antifungal stewardship (AFS) in inpatient settings are needed in small/middle-sized hospitals as well as large hospitals
The median number for each staff subtype engaged in antimicrobial stewardship programs (ASP) were as follows: medical doctors 2 (1–3), infectious disease specialists (IDS) 1 (0–1), nurses 1 (1, 2), infection control nurses (ICN) 1 (1), pharmacists 2 (1, 2), infectious disease chemotherapy pharmacists (IDCP) 0 (0–1), clinical microbiologists 1 (1, 2), and officers 0 (0– 1)
One of the efficient AMS and AFS activities with limited resources, we suggest the education about the principle of appropriate use of antimicrobials and antifungals, to ensure that appropriate use is made without the intervention of antimicrobial steward team (AST) staff
Summary
Both antimicrobial stewardship (AMS) and antifungal stewardship (AFS) in inpatient settings are needed in small/middle-sized hospitals as well as large hospitals. To encourage small/middle-sized hospitals to adopt AMS, the Infectious Diseases Society. Since 2018, there have been financial incentives for antimicrobial stewardship programs (ASP) under the national health insurance system towards small/middle-sized hospitals as well as large hospitals in Japan. The importance of antifungal stewardship (AFS) in hospitals is emphasized in some studies because while fungal infections in inpatients are less common than bacterial infections, they are more lethal and costlier to treat [9,10,11]. The global emergence of antifungal resistance among Candida spp. and Aspergillus spp. is a growing threat to public health driven largely by the expanding use of antifungals in both clinical and agricultural settings [14]
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