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

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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.

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Acknowledgements

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

Author information

Authors and Affiliations

  1. Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Takeshi Kimura, Atsushi Uda, Tomoyuki Sakaue, Kazuhiko Yamashita, Tatsuya Nishioka, Takeshi Ioroi, Midori Hirai & Ikuko Yano

  2. Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, Japan

    Takeshi Kimura, Atsushi Uda, Tatsuya Nishioka, Sho Nishimura, Kei Ebisawa, Manabu Nagata, Goh Ohji, Tatsuya Nakamura, Chihiro Koike, Mari Kusuki & Issei Tokimatsu

  3. Department of Infectious Disease, Kobe University Hospital, Kobe, Hyogo, Japan

    Sho Nishimura, Kei Ebisawa, Manabu Nagata, Goh Ohji & Kentaro Iwata

  4. Department of Clinical Laboratory, Kobe University Hospital, Kobe, Hyogo, Japan

    Tatsuya Nakamura & Mari Kusuki

  5. Faculty of Pharmaceutical Sciences, Setsunan University, Osaka, Japan

    Akira Mukai

  6. Abe Internal Medicine Clinic, Kobe, Hyogo, Japan

    Yasuhisa Abe

  7. Hyogo Clinical Laboratory Corporation, Himeji, Hyogo, Japan

    Hiroyuki Yoshida

  8. Sanda City Hospital, Sanda, Hyogo, Japan

    Soichi Arakawa

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  1. Takeshi Kimura
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  2. Atsushi Uda
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Corresponding author

Correspondence to Takeshi Kimura.

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Kimura, T., Uda, A., Sakaue, T. et al. Long-term efficacy of comprehensive multidisciplinary antibiotic stewardship programs centered on weekly prospective audit and feedback. Infection 46, 215–224 (2018). https://doi.org/10.1007/s15010-017-1099-8

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  • DOI: https://doi.org/10.1007/s15010-017-1099-8

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