Antimicrobial stewardship programme in critical care medicine: A prospective interventional study

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Health Economics

Background:

• Hospital antimicrobial stewardship programmes (ASPs) optimize antimicrobial use and reduce costs in general wards.
• The effectiveness of ASPs in intensive care units (ICUs) requires specific evaluation due to unique patient populations and infection pressures.

Purpose of the Study:

• To evaluate the impact of a prospective audit and feedback antimicrobial stewardship programme implemented in a tertiary hospital's medical intensive care unit.
• To assess changes in antimicrobial consumption, costs, multi-drug resistant microorganism (MDRM) prevalence, and patient outcomes.

Main Methods:

• A prospective interventional, before-and-after study design was employed in a 24-bed medical ICU.
• Data on antimicrobial consumption, costs, MDRM, nosocomial infections, ICU length of stay, and mortality were collected and compared pre- and post-intervention.
• A one-year intervention involved a prospective audit and feedback antimicrobial stewardship programme with 61 team meetings.

Main Results:

• Total antimicrobial consumption (DDD/100 patient-days) decreased by 22.4% (p=0.037), with significant reductions in specific antibiotic classes.
• Overall antimicrobial spending decreased by €119,636.
• No significant changes were observed in MDRM isolation, nosocomial infections incidence, ICU length of stay, or mortality rates.

Conclusions:

• An ICU-based antimicrobial stewardship programme effectively reduced antimicrobial use and associated costs.
• The implementation of an ICU ASP is supported by these findings, demonstrating benefits without adverse effects on patient outcomes like mortality or length of stay.