Effectiveness and Acceptance of Multimodal Antibiotic Stewardship Program: Considering Progressive Implementation and...

Area of Science:

• Infectious Diseases
• Hospital Pharmacy
• Antimicrobial Resistance

Background:

• Antibiotic stewardship programs (ASPs) are crucial for combating antimicrobial resistance.
• The synergistic effects of various ASP intervention modes have not been fully evaluated.

Purpose of the Study:

• To assess the complementarity of sequentially implemented interventions within an antibiotic stewardship program.
• To evaluate the impact of combined ASP interventions on antibiotic prescribing patterns.

Main Methods:

• A 938-bed hospital sequentially implemented four interventions over one year, coordinated by an infectious diseases specialist (IDS).
• Interventions included: on-request IDS consulting, ICU meeting participation, IDS alerts triggered by microbiology, and IDS alerts triggered by pharmacist alerts.
• Quantitative and qualitative analyses of electronic medical records were used to assess intervention complementarity and impact.

Main Results:

• The number of interventions doubled after implementing pharmacist-triggered alerts.
• Pharmacist-triggered interventions were more effective in de-escalating or stopping antibiotic therapy (63%) compared to on-request consultations (32%).
• A significant overall decrease of 14.6% in antibiotic use was observed (p = 0.03).

Conclusions:

• Sequential implementation of combined interventions demonstrates clear complementarity within ASPs.
• Integrated ASP strategies can significantly reduce overall antibiotic consumption, particularly for critical antibiotic prescriptions.
• These combined interventions are well-accepted by healthcare prescribers.