Role of Antimicrobial Stewardship in Modulating Antibiotic Use and Mitigating Bacterial Resistance in a Tertiary Care...

Despite the widespread adoption of antimicrobial stewardship (AMS) programs, their effectiveness varies because of differing regional policies and socioeconomic factors. This study aimed to assess the impact of AMS at a Chinese tertiary care hospital on inpatient antimicrobial use and bacterial resistance during the COVID-19 outbreak.

An interrupted time-series regression analysis was conducted to compare inpatient antimicrobial use between pre- and post-intervention periods. The Chi-squared test and linear regression analysis were used to compare bacterial resistance and illustrate temporal trends in bacterial resistance, respectively.

Following the AMS strategy implementation, we observed a significant decrease in antimicrobial consumption at unrestricted (β2 = -6.38, P = 0.004), restricted (β2 = -17.81, P < 0.001), and special levels (β2 = -2.32, P < 0.001). Despite a reduction in the use of third-generation cephalosporins and macrolides (β2 = -6.85, P < 0.001; β2 = -2.82, P < 0.001), an increase in the trend of use was observed post-intervention (β3 = 0.15, P < 0.001; β3 = 0.04, P = 0.001). Methicillin resistance in Staphylococcus aureus significantly decreased (β = -0.23, P < 0.001) from 52.85% to 40.92%. Conversely, the prevalence of carbapenem-resistant Klebsiella pneumonia increased from 4.69% to 10.87% (P < 0.001), whereas resistance to Acinetobacter baumannii and Pseudomonas aeruginosa marginally decreased (P<0.05). We observed decreases in the antimicrobial utilization rate (β2 = -11.86, P = 0.003) and combination utilization rate (β2 = -12.36, P = 0.011) post-intervention. No significant changes in special-level antimicrobial and prophylactic agent use in category I incisional surgeries were observed.

An AMS program in a Chinese tertiary facilitated effective management of antimicrobial use and reduction of bacterial resistance during the COVID-19 pandemic, in the context of combined infection prevention and control measures. The findings provide useful insights for the implementation of antimicrobial stewardship in future public health crises.