Sustaining Antimicrobial Stewardship in a High-Antibiotic Resistance Setting

Area of Science:

• Antimicrobial stewardship
• Infectious disease epidemiology
• Health informatics

Background:

• Limited long-term data exist on the intended and unintended consequences of prospective review and feedback (PRF) and computerized decision support systems (CDSS) in antimicrobial stewardship.
• Understanding these impacts is crucial for optimizing antibiotic use and combating antimicrobial resistance.

Purpose of the Study:

• To evaluate the outcomes of sequentially implementing PRF and CDSS interventions.
• To assess changes in antibiotic use, incidence of multidrug-resistant organisms (MDROs), and unintended consequences over time.

Main Methods:

• A retrospective cohort study utilizing interrupted time series with segmented regression analysis.
• Data from January 2007 to December 2018 were extracted from electronic medical records at a Singaporean university teaching hospital.
• Interventions included PRF (2009), hospital-wide CDSS (2011), and partial lifting of CDSS (2017).

Main Results:

• Following CDSS implementation (intervention 2), use of piperacillin-tazobactam and carbapenems decreased, as did the use of other broad-spectrum antibiotics.
• The incidence of Clostridioides difficile significantly decreased after CDSS implementation.
• Lifting CDSS partially (intervention 3) led to an increase in piperacillin-tazobactam and carbapenem use.

Conclusions:

• Concurrent PRF and CDSS implementation effectively limited the use of specific broad-spectrum antibiotics and reduced the incidence of other broad-spectrum antibiotic use.
• These antimicrobial stewardship interventions were associated with a decrease in Clostridioides difficile infections.
• The findings highlight the sustained impact of integrated PRF and CDSS on antimicrobial use and resistance patterns.