Pharmacy World and Science

, Volume 28, Issue 4, pp 257–264 | Cite as

The impact of an intensive antimicrobial control program in a Taiwanese medical center

  • Ming-Tsung Chang
  • Tzu-Hua Wu
  • Chun-Yu Wang
  • Tsrang-Neng Jang
  • Chien-Yu Huang
Research Article



The study evaluates the short term impacts of an intensive control program for the appropriate us of antimicrobials, and to provide a novel strategy for antimicrobial control in inpatient wards in Taiwan.


In September 2002, a dual intensive antimicrobial control program was implemented within a 921-bed medical center in Taiwan. The study sample included all patients admitted to the medical center during the basal period (October–December 2001) and the intervention period (October–December 2002), where at least one type of parenteral antimicrobial was administered. The sample comprised of 5046 patients during the basal period and 5054 patients during the intervention period.

Main outcome measure

Analysis of the impact of the intensive antimicrobial control program was undertaken by comparing clinical outcomes, parenteral antimicrobial consumption and bacterial susceptibilities, before and after the establishment of the intensive antimicrobial control program.


No statistical differences were found between the basal and intervention periods with regard to either the demographic variables, such as age and gender, or the incidence of nosocomial infections. The clinical outcomes, including length of stay in the medical center, mortality and readmission rates, were also similar for both periods. As compared to the basal period, the consumption of parenteral antimicrobials—in defined daily doses (DDDs) per 100 patient days (PDs)—declined by 13.2% during the intervention period (71.2 vs. 61.8). There were significant increases in the susceptibilities of Pseudomonas aeruginosa to both amikacin and ciprofloxacin, and Serratia spp. to ciprofloxacin (P < 0.05), while all others remained stable.


This study reports positive responses to intensive antimicrobial control measures among health professionals within a Taiwanese medical center. Following the implementation of the intensive control program, both prescriptions and consumption levels of parenteral antimicrobials were reduced without compromising the clinical outcomes of patients, while the susceptibility patterns of bacterial organisms mostly remained stable. Long-term control of parenteral antimicrobials under such a program may well produce significant benefits for inpatients through the overall rationalization of antimicrobial usage, leading to potential reductions in both the␣incidence of adverse effects and the burden of resistant organisms. A method of incorporating this intensive control program into a computerized prescription order system is currently under construction.


Antimicrobial control program Inpatients Parenteral antimicrobials Rationalized antimicrobial usage Susceptibility Taiwan 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



We wish to thank K.Y. Hsu, Director of the Department of Pharmacy, Taipei Medical University and H.C. Chiu, Vice-president of Shin Kong Wu Ho-Su Memorial Hospital, for their critical review of this paper. We also wish to acknowledge the support provided by pharmacists and members of the Infection Control Committee, which is greatly appreciated.


  1. 1.
    Ho M, Hsiung CA, Yu HT, Chi CL, Chang HJ. Changes before and after a policy to restrict antimicrobial usage in upper respiratory infections in Taiwan. Int J Antimicrob Agents 2004;23:438–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Kunin CM. Resistance to antimicrobial drugs–a worldwide calamity. Ann Intern Med 1993;118:557–61.PubMedGoogle Scholar
  3. 3.
    Cars O, Molstad S, Melander A. Variation in antibiotic use in the European Union. Lancet 2001;357:1851–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Molstad S, Cars O. Major change in the use of antibiotics following a national programme: Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (STRAMA). Scand J Infect Dis 1999;31:191–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Mazzeo F, Capuano A, Avolio A, Filippelli A, Rossi F. Hospital-based intensive monitoring of antibiotic-induced adverse events in a university hospital. Pharmacol Res 2005; 51:269–74.PubMedCrossRefGoogle Scholar
  6. 6.
    Steinman MA, Gonzales R, Linder JA, Landefeld CS. Changing use of antibiotics in community-based outpatient practice, 1991–1999. Ann Intern Med 2003;138:525–33.PubMedGoogle Scholar
  7. 7.
    Finkelstein JA, Davis RL, Dowell SF, Metlay JP, Soumerai SB, Rifas-Shiman SL. Reducing antibiotic use in children: a randomized trial in 12 practices. Pediatrics 2001;108:1–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Bassetti M, Di Biagio A, Rebesco B, Amalfitano ME, Topal J, Bassetti D. The effect of formulary restriction in the use of antibiotics in an Italian hospital. Eur J Clin Pharmacol 2001; 57:529–34.PubMedCrossRefGoogle Scholar
  9. 9.
    Saizy-Callaert S, Causse R, Furhman C, Le Paih MF, Thebault A. Chouaid C. Impact of a multidisciplinary approach to the control of antibiotic prescription in a general hospital. J Hosp Infect 2003;53:177–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Geissler A, Gerbeaux P, Granier I, Blanc P, Facon K, Durand-Gasselin J. Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs. Intensive Care Med 2003;29:49–54.PubMedGoogle Scholar
  11. 11.
    Ruttimann S, Keck B, Hartmeier C, Maetzel A, Bucher HC. Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital. Clin Infect Dis 2004;38:348–56.PubMedCrossRefGoogle Scholar
  12. 12.
    Ho M, McDonald LC, Lauderdale TL, Yeh LL, Chen PC, Shiau YR. Surveillance of antibiotic resistance in Taiwan, 1998. J Microbiol Immunol Infect 1999;32:239–49.PubMedGoogle Scholar
  13. 13.
    Hsueh PR, Liu CY, Luh KT. Current status of antimicrobial resistance in Taiwan. Emerg Infect Dis 2002;8:132–7.PubMedGoogle Scholar
  14. 14.
    Chang SC, Hsieh WC, Liu CY. High prevalence of antibiotic resistance of common pathogenic bacteria in Taiwan. The Antibiotic Resistance Study Group of the Infectious Disease Society of the Republic of China. Diagn Microbiol Infect Dis 2000;36:107–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Ho M. Taiwan seeks to solve its resistance problems. Science 2001;291:2550–1.PubMedCrossRefGoogle Scholar
  16. 16.
    Taiwan Bureau of National Health Insurance. Regulation No. 9003788. [in Chinese] http// (12 Jan. 2001).Google Scholar
  17. 17.
    Chen HM, Chung PW, Yu YJ, Tai WL, Kao WL, Chien YL, et al. Antimicrobial susceptibility of common bacterial pathogens isolated from a new regional hospital in southern Taiwan. Chang Gung Med J 2003;26:889–96.PubMedGoogle Scholar
  18. 18.
    Hu S, Liu X, Peng Y. Assessment of antibiotic prescription in hospitalized patients at a Chinese university hospital. J Infect 2003;46:161–3.PubMedCrossRefGoogle Scholar
  19. 19.
    McDonald LC, Yu HT, Yin HC, Hsiung AC, Ho M. Use and abuse of surgical antibiotic prophylaxis in hospitals in Taiwan. J Formos Med Assoc 2001;100:5–13.PubMedGoogle Scholar
  20. 20.
    Hermosilla Najera L, Canut Blasco A, Ulibarrena Sanz M, Abasolo Osinaga E, Abecia Inchaurregui LC. Trends in antimicrobial utilization at a Spanish general hospital during a 5-year period. Pharmacoepidemiol Drug Saf 2003;12:243–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Buck CJ (2001) ICD-9-CM, volumes 1, 2, and 3. W. B. Saunders, Singapore, 2003. ISBN 981-4141-81-X.Google Scholar
  22. 22.
    WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index 2004. (22 Feb. 2004).Google Scholar
  23. 23.
    WHO Collaborating Centre for Drug Statistics Methodology. About the ATC/DDD system. http://www/whocc. no.atcddd (22 Feb. 2004).Google Scholar
  24. 24.
    Goldmann DA, Weinstein RA, Wenzel RP, Tablan OC, Duma RJ, Gaynes RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. Jama 1996;275:234–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Gould IM. A review of the role of antibiotic policies in the control of antibiotic resistance. J Antimicrob Chemother 1999;43:459–65.PubMedCrossRefGoogle Scholar
  26. 26.
    Gould IM. Antibiotic policies and control of resistance. Curr Opin Infect Dis 2002;15:395–400.PubMedGoogle Scholar
  27. 27.
    Bassetti M, Di Biagio A, Rebesco B, Cenderello G, Amalfitano ME, Bassetti D. Impact of an antimicrobial formulary and restriction policy in the largest hospital in Italy. Int J Antimicrob Agents 2000;16:295–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Infection Control Committee. Antimicrobial Susceptibility Data for the Clinical Isolated Pathogens in the Year 2001 (July-December). Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 2002.Google Scholar
  29. 29.
    Gonlugur U, Bakici MZ, Ozdemir L, Akkurt I, Icagasioglu S, Gultekin F. Retrospective analysis of antibiotic susceptibility patterns of respiratory isolates of Pseudomonas aeruginosa in a Turkish University Hospital. Ann Clin Microbiol Antimicrob 2003; 2:5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Ming-Tsung Chang
    • 1
    • 2
  • Tzu-Hua Wu
    • 2
  • Chun-Yu Wang
    • 1
  • Tsrang-Neng Jang
    • 3
    • 4
  • Chien-Yu Huang
    • 2
  1. 1.Department of PharmacyShin Kong Wu Ho-Su Memorial HospitalTaipeiTaiwan
  2. 2.Department of Clinical Pharmacy, School of PharmacyTaipei Medical UniversityTaipeiTaiwan, ROC
  3. 3.Section of Infectious Diseases, Department of MedicineShin Kong Wu Ho-Su Memorial HospitalTaipeiTaiwan
  4. 4.Infection Control CommitteeShin Kong Wu Ho-Su Memorial HospitalTaipeiTaiwan

Personalised recommendations