Background: Antimicrobial Stewardship was introduced in 2014 in a general hospital (14.000 admissions). The goal was to optimize antimicrobial prescribing in order to improve individual patient care and to decrease the spread of antimicrobial resistance. Interventions and the antibiotic use over 2014 and 2015 were registered
Methods: Strategies for changing antimicrobial prescribing behaviour included education of prescribers, new antimicrobial guidelines and appropriate use of antimicrobial drugs. 1. The antimicrobial committee created a new antimicrobial formulary with restricted prescribing of antimicrobial agents. 2. The antibiotic team (A-team) was installed, including an infectious diseases specialist, a hospital based pharmacist and a medical microbiologist. 3. The A-team visited all clinical wards twice a week. The A-team aimed to reduce the use of amoxicillin/clavulanic acid and ciprofloxacin in 2015 because of the increasing resistance of microorganisms. Cefazolin was introduced as the new antibiotic prophylaxis in surgery. The prescribing behaviour was measured.
Results: In 2014 (Q3-4) and 2015 (Q1-4), respectively 413 and 1019 patients were discussed by the A-team and the interventions registered (figure 1). The mean intervention per patient was reduced from 0.51 to 0.41. The dispensing of intravenous amoxicillin/clavulanic acid and ciprofloxacin, and their antibiotic use density (DDD/100 patient days) decreased significantly (figure 2). The use of preoperative cefazolin increased 1016%.
Figure 1. Distribution of proposed interventions
Figure 2. Antibiotic use
Conclusion: The A-team had direct control over antimicrobial use. A change in antimicrobial prescribing behaviour was seen. The average number of interventions per patient decreased 14,7%. The stop antibiotic intervention decreased 63%. Some intervention increased, signaling a delay in decision making until the A-team visited the ward. A reduction of the amount of amoxicillin/clavulanic acid (42-51%) and ciprofloxacin (20-30%) and increase of the use of preoperative cefazolin (1016%) was seen. The resistance data show no significant change with the exception of ciprofloxacin (reduced from 13.7 to 10.9%).
G. Van Asselt,
S. Lugtenburg, None
C. Roggeveen, None
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