Assuring Adequate Antimicrobial Stewardship Improves Physicians' attitudes Towards Prescribing Antibiotics and Suppresses Antibiotic Use

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  • NISHIGAKI Tetsuta
    Infection Prevention and Control Department, Yokohama City University Hospital Pharmaceutical Department, Yokohama City University Hospital
  • KATO Hideaki
    Infection Prevention and Control Department, Yokohama City University Hospital
  • SUZUKI Tomoyo
    Infection Prevention and Control Department, Yokohama City University Hospital Pharmaceutical Department, Yokohama City University Hospital
  • SANO Kayoko
    Infection Prevention and Control Department, Yokohama City University Hospital Clinical Laboratory Department, Yokohama City University Hospital
  • NAKAMURA Kana
    Infection Prevention and Control Department, Yokohama City University Hospital
  • HORITA Nobuyuki
    Chemotherapy Center, Yokohama City University Hospital
  • SAHASHI Yukiko
    Pharmaceutical Department, Yokohama City University Hospital

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  • 薬剤師の専従化による抗菌薬適正使用支援チーム（AST）の活動実績と臨床医の受け入れ率の変化

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Abstract

<p>Purpose: Implementing antimicrobial stewardship (AS) improves the quality of medical care by optimizing antimicrobial prescription. Assuring an appropriate amount of time for performance prospective audit and feedback can be challenging.</p><p>Methods: We retrospectively analyzed 1,094 AS interventions, provided either three times a week (period A), every weekday by a part-time pharmacist (period B), or every weekday by a full-time pharmacist (period C). We compared physicians' acceptance rates, antibiotic use rate, duration of hospitalization, identification rate of multi-drug-resistant microorganisms, and incidence of Clostridioides difficile infection among the different intervention periods.</p><p>Results: The median monthly number of AS interventions in periods A, B and C were 18, 27 and 47, respectively. The number of AS interventions showed a positive correlation with the physicians' acceptance rate (R=0.685, p< 0.001) and a negative correlation with broad-spectrum antibiotic and carbapenem usage (R=-0.386, p=0.020 and R=-0.614, p< 0.001). The interrupted time series analysis revealed that as compared to period A, physicians' acceptance rates rose by 26.1% (95% CI 18.4, 33.7) in period B and by 9.7% (95% CI 2.0, 17.3) in period C. Broad-spectrum antibiotic and carbapenem use in period B decreased by −16.85 (95% CI −27.49, −6.21) and −15.84 (95% CI −19.48, −12.21), respectively, as compared with that in period A.</p><p>Conclusions: Adequately frequent AS interventions decrease the need for antimicrobial usage. Assuring an adequate amount of work time for the AS staff improved the physicians' acceptance rate and prescription rate of antibiotics.</p>

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 96 (4), 132-139, 2022-07-20

    The Japanese Association for Infectious Diseases

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