Evaluation of an antibiotic stewardship program for promoting rational antibiotic use in an ICU in China

The irrational use of broad-spectrum antibiotics in intensive care units (ICUs) has led to increasing bacterial resistance in recent years. However, research on the effectiveness of antimicrobial stewardship programs (ASPs) in Chinese ICUs is limited. This study aimed to assess the impact of ASP implementation on antibiotic use and bacterial resistance in a Chinese ICU.

This retrospective, interventional study employed an interrupted time series design and was conducted in an ICU beginning on June 1, 2019. The ASP included the formation of a multidisciplinary team, the development of facility-specific criteria, prescriber education, the implementation of preauthorization processes, and retrospective prescription audit and feedback (RPAF). Patient data were collected from June 1, 2018, to May 31, 2020. An interrupted time series analysis was used to evaluate the impact of the ASP.

A total of 862 patients were admitted during the pre-intervention period, and 946 patients were admitted during the post-intervention period. The interrupted time series analysis demonstrated a reduction in the monthly consumption of carbapenems (β3: -2.25 DDD/100 PD, p < 0.001) and linezolid (β3: -0.49 DDD/100 PD, p = 0.003) after the intervention. Additionally, a decrease in the incidence of bacteremia caused by multidrug-resistant (MDR) organisms overall (β3:-0.03 events/100 PD, p = 0.036) and MDR Gram-positive organisms (β3:-0.01 events/100 PD, p = 0.002) was observed post-intervention.

Reduced antimicrobial consumption and decreased incidence of infections associated with MDR organisms were observed following the implementation of an ASP strategy that incorporated clinical pharmacists as core team members.

Not applicable.