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Infection

, Volume 46, Issue 2, pp 215–224 | Cite as

Long-term efficacy of comprehensive multidisciplinary antibiotic stewardship programs centered on weekly prospective audit and feedback

  • Takeshi Kimura
  • Atsushi Uda
  • Tomoyuki Sakaue
  • Kazuhiko Yamashita
  • Tatsuya Nishioka
  • Sho Nishimura
  • Kei Ebisawa
  • Manabu Nagata
  • Goh Ohji
  • Tatsuya Nakamura
  • Chihiro Koike
  • Mari Kusuki
  • Takeshi Ioroi
  • Akira Mukai
  • Yasuhisa Abe
  • Hiroyuki Yoshida
  • Midori Hirai
  • Soichi Arakawa
  • Ikuko Yano
  • Kentaro Iwata
  • Issei Tokimatsu
Original Paper

Abstract

Objective

To evaluate the long-term effects of comprehensive antibiotic stewardship programs (ASPs) on antibiotic use, antimicrobial-resistant bacteria, and clinical outcomes.

Design

Before–after study.

Setting

National university hospital with 934 beds.

Intervention

Implementation in March 2010 of a comprehensive ASPs including, among other strategies, weekly prospective audit and feedback with multidisciplinary collaboration.

Methods

The primary outcome was the use of antipseudomonal antibiotics as measured by the monthly mean days of therapy per 1000 patient days each year. Secondary outcomes included overall antibiotic use and that of each antibiotic class, susceptibility of Pseudomonas aeruginosa, the proportion of patients isolated methicillin-resistant Staphylococcus aureus (MRSA) among all patients isolated S. aureus, the incidence of MRSA, and the 30-day mortality attributable to bacteremia.

Results

The mean monthly use of antipseudomonal antibiotics significantly decreased in 2011 and after as compared with 2009. Susceptibility to levofloxacin was significantly increased from 2009 to 2016 (P = 0.01 for trend). Its susceptibility to other antibiotics remained over 84% and did not change significantly during the study period. The proportion of patients isolated MRSA and the incidence of MRSA decreased significantly from 2009 to 2016 (P < 0.001 and = 0.02 for trend, respectively). There were no significant changes in the 30-day mortality attributable to bacteremia during the study period (P = 0.57 for trend).

Conclusion

The comprehensive ASPs had long-term efficacy for reducing the use of the targeted broad-spectrum antibiotics, maintaining the antibiotic susceptibility of P. aeruginosa, and decreasing the prevalence of MRSA, without adversely affecting clinical outcome.

Keywords

Antibiotic stewardship Prospective audit and feedback Multidisciplinary collaboration Long-term efficacy 

Notes

Acknowledgements

We are grateful to everyone who contributed to the antibiotic stewardship program in our hospital.

Compliance with ethical standards

Conflict of interest

All authors report no conflicts of interest relevant to this article.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Takeshi Kimura
    • 1
    • 2
  • Atsushi Uda
    • 1
    • 2
  • Tomoyuki Sakaue
    • 1
  • Kazuhiko Yamashita
    • 1
  • Tatsuya Nishioka
    • 1
    • 2
  • Sho Nishimura
    • 2
    • 3
  • Kei Ebisawa
    • 2
    • 3
  • Manabu Nagata
    • 2
    • 3
  • Goh Ohji
    • 2
    • 3
  • Tatsuya Nakamura
    • 2
    • 4
  • Chihiro Koike
    • 2
  • Mari Kusuki
    • 2
    • 4
  • Takeshi Ioroi
    • 1
  • Akira Mukai
    • 5
  • Yasuhisa Abe
    • 6
  • Hiroyuki Yoshida
    • 7
  • Midori Hirai
    • 1
  • Soichi Arakawa
    • 8
  • Ikuko Yano
    • 1
  • Kentaro Iwata
    • 3
  • Issei Tokimatsu
    • 2
  1. 1.Department of PharmacyKobe University HospitalKobeJapan
  2. 2.Department of Infection Control and PreventionKobe University HospitalKobeJapan
  3. 3.Department of Infectious DiseaseKobe University HospitalKobeJapan
  4. 4.Department of Clinical LaboratoryKobe University HospitalKobeJapan
  5. 5.Faculty of Pharmaceutical SciencesSetsunan UniversityOsakaJapan
  6. 6.Abe Internal Medicine ClinicKobeJapan
  7. 7.Hyogo Clinical Laboratory CorporationHimejiJapan
  8. 8.Sanda City HospitalSandaJapan

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