Prescribing trends before and after implementation of an antimicrobial stewardship program

Area of Science:

• Infectious Diseases
• Hospital Administration
• Public Health

Background:

• Antimicrobial resistance (AMR) is a growing global health threat.
• Antimicrobial stewardship programs (ASPs) are crucial for optimizing antimicrobial use and curbing resistance.
• Inappropriate antimicrobial prescribing necessitates effective stewardship interventions.

Purpose of the Study:

• To evaluate the impact of an implemented antimicrobial stewardship program on broad-spectrum antimicrobial utilization.
• To assess changes in the use of restricted antimicrobials in a tertiary care hospital.

Main Methods:

• An observational study utilizing interrupted time series analysis with a historical control.
• Data collected from a tertiary referral hospital over a 30-month baseline and an 18-month intervention period.
• Key metrics included stewardship team recommendations and monthly rates of broad-spectrum antimicrobial use.

Main Results:

• The ASP team made 1104 recommendations for 779 patients, with 64% advocating for therapy cessation, de-escalation, or switch to oral administration.
• An immediate 17% reduction in broad-spectrum antimicrobial use was observed in the ICU, and a 10% reduction outside the ICU.
• Significant reductions in cephalosporin and glycopeptide use were noted, though partially offset by increased use of beta-lactam/beta-lactamase inhibitors.

Conclusions:

• The introduction of an ASP, incorporating postprescription review, led to an immediate decrease in broad-spectrum antimicrobial use.
• The effectiveness of the stewardship intervention waned over the study period.
• Sustained antimicrobial stewardship efforts are necessary to maintain reductions in broad-spectrum antimicrobial use.