Abstract
Objective: The objective of the study was to assess the impact of multifaceted clinical pharmacist-led antimicrobial stewardship (AMS) program on the rational use of antibiotics for patients who receive vascular and interventional radiology therapies. Methods: A quasi-experimental retrospective intervention design with a comparison group was applied to the practice of antibiotic use in the department of vascular and interventional radiology in a Chinese tertiary hospital. We used difference-in-differences (DID) analysis to compare outcomes before and after the AMS intervention between the intervention group and control group, to determine whether intervention would lead to changes in irrationality of antibiotic prescribing, antibiotic utilization, cost of antibiotics, and length of hospital stay. Results: The DID results showed that the intervention group was associated with a reduction in the average consumption of antibiotics (p = 0.017) and cost of antibiotics (p = 0.006) and cost per defined daily dose (DDD) (p = 0.000). There were no significant differences in the mean change of total costs and length of stay between the two groups (p > 0.05). The average inappropriate score of perioperative antimicrobial prophylaxis in the intervention group declined by 0.23, while it decreased by 0.02 in the control group [0.21 (95% CI, −0.271 to −0.143); p = 0.000]. The average inappropriate score of non-surgical antimicrobial prophylaxis in the intervention group declined by 0.14, while it increased by 0.02 in the control group [0.16 (95% CI, −0.288 to −0.035); p = 0.010]. The average inappropriate score of the therapeutic use of antibiotics in the intervention group declined by 0.07, while it decreased by 0.01 in the control group [0.06 (95% CI, −0.115 to −0.022); p = 0.003]. Conclusions: This study provides evidence that implementation of AMS interventions was associated with a marked reduction of antibiotic use, cost of antibiotics, and irrationality of antibiotic prescribing in China.
Highlights
By making lethal infections readily treatable, antibiotics have led the development of modern medicine
The DID results suggested that the intervention group was associated with a reduction in the average consumption of antibiotics [1.84 defined daily dose (DDD); p = 0.017], cost of antibiotics [598.19 RMB; p = 0.006], and cost per DDD [70.5 RMB; p = 0.000]
Some studies reported that the length of hospital stay significantly was shortened after the intervention of a pharmacist-directed antimicrobial stewardship (Mahmoudi et al, 2019; Xin et al, 2019; Arensman et al, 2020; Mahrous et al, 2020), while some studies indicated that the intervention had no effect on the length of stay (Wenzler et al, 2017; Abubakar et al, 2019; Monmaturapoj et al, 2021), which may be related to differences in the study design and analytical methods
Summary
By making lethal infections readily treatable, antibiotics have led the development of modern medicine. Prompt initiation of appropriate antibiotic therapy to treat infectious diseases reduces morbidity and save lives. Antimicrobial resistance (AMR) has been recognized as a growing public health problem of huge concern to countries around the world (Huemer et al, 2020). Inappropriate antibiotic use contributes greatly to the development of AMR (Bohmer et al, 2021), leading to ineffective therapy, increase in adverse reactions, and escalation in health care costs. In order to optimize antibiotic use in medical care, many different antimicrobial stewardship (AMS) initiatives have been conducted in some developed countries recently. Several studies have shown that AMS can help physicians increase infection cure rates, improve treatment outcomes, and reduce antibiotic resistance by improving antibiotic prescribing (Dellit et al, 2007; Rice, 2018)
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