Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Public Health

Background:

• Limited data exists on the long-term impact of non-restrictive antimicrobial stewardship (AMS) strategies.
• Intensive care units (ICUs) are critical settings for monitoring antibiotic use due to high consumption and resistance risks.
• Evaluating sustained effects of AMS programs is essential for optimizing antibiotic use and combating antimicrobial resistance.

Purpose of the Study:

• To assess the long-term effects of a stepwise, multimodal, non-restrictive AMS program on antibiotic use in the ICU.
• To evaluate the impact of the AMS program on broad-spectrum antibiotic consumption.
• To determine changes in the appropriateness of antibiotic prescribing over an eight-year period.

Main Methods:

• A prospective, 8-year study (2011-2019) involving a stepwise implementation of a non-restrictive AMS program in an ICU.
• Antibiotic use was measured in DDD per 100 patient-days (PD).
• Monthly point-prevalence surveys assessed antibiotic prescribing appropriateness; Poisson regression analyzed trends.

Main Results:

• Overall antibiotic use decreased by 23% (from 185.4 to 141.9 DDD/100 PD).
• Broad-spectrum antibiotic use showed an initial increase followed by a sustained 10% annual reduction post-2016.
• Appropriateness of antibiotic prescribing significantly improved, increasing by 11% annually (p=0.048).

Conclusions:

• A stepwise, multimodal, non-restrictive AMS program can achieve sustained reductions in broad-spectrum antibiotic use in ICUs.
• The implemented AMS strategy significantly improved the appropriateness of antibiotic prescribing over the long term.
• This approach provides a viable model for optimizing antibiotic use in critical care settings without restrictive measures.