Implementing effective, hospital-based antimicrobial stewardship is challenging because broad-spectrum antimicrobials are frequently needed for treating healthcare-associated infection, which is predominantly caused by multi-drug resistant organisms. We chronologically instituted prospective audit and feedback (PAF) interventions targeting carbapenem and piperacillin/tazobactam use in an inpatient setting. The aim of this study was to evaluate the effectiveness of PAF and its impact on the use of other antipseudomonal agents.
A before-after study was conducted from April 2012 to March 2016 at a 790-bed, tertiary care medical center in Tokyo, Japan. A once-weekly PAF of carbapenems (from April 2014) followed by piperacillin/tazobactam (from May 2015) was initiated. Antimicrobial use was measured as days of therapy (DOT) per 1,000 patient-days. The use of carbapenems, piperacillin/tazobactam, and other antipseudomonal agents including cefepime, intravenous fluoroquinolones, ceftazidime, and aztreonam was assessed by means of an interrupted time series.
As a result of implementing PAF, a decrease in the monthly use of carbapenems (from 21.1 DOT per 1,000 patient-days in the pre-intervention period to 8.34 DOT per 1,000 patient-days) and piperacillin/tazobactam (from 26.3 DOT per 1,000 patient-days to 17.0 DOT per 1,000 patient-days) was observed in the subsequent intervention period. In the time series model, PAF resulted in an immediate and gradual decrease in piperacillin/tazobactam use (P=0.005 for intercept and P=0.04 for trend). Although overall intravenous antipseudomonal agent use remained unchanged, cefepime (11.3 DOT per 1,000 patient-days to 31.4 DOT per 1,000 patient-days), ceftazidime (3.1 DOT per 1,000 patient-days to 4.7 DOT per 1,000 patient-days), and aztreonam (0.2 DOT per 1,000 patient-days to 2.3 DOT per 1,000 patient-days) use increased in the subsequent intervention period.
A prospective audit and feedback for broad spectrum antimicrobials appears to be effective in reducing the use of targeted antimicrobials including carbapenems and piperacillin/tazobactam, and in de-escalating to other antipseudomonal agents. However, hospital-based antimicrobial stewardships need to be promoted further in order to decrease the overall use of antipseudomonal agents in inpatient settings.
M. Higuchi, None
S. Murakami, None
Y. Tagashira, None
Y. Tokuda, None
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