Division of Pediatric General Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Molecular Infectious Disease Research Center, Department of Medical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
J Microbiol Immunol Infect. 2017 Dec;50(6):846-856. doi: 10.1016/j.jmii.2015.10.006. Epub 2015 Nov 19.
We aimed to report the implementation of an antimicrobial stewardship program (ASP) guided by clinically significant cultures in a hospital to assess its pharmaceutical, microbiological, financial, and outcome effects.
A 3-year cohort study of an antimicrobial restriction policy implementation was performed. The ASP with culture-guided de-escalation of antibiotics was instituted in a local hospital since January 1, 2012. The cost of antimicrobials, defined daily dose (DDD), susceptibility to antimicrobials, and outcome of all admitted patients were calculated and evaluated before and after the ASP implementation.
Average monthly length of stay of admitted patients decreased from 7.8 ± 0.5 days in 2011 to 6.9 ± 0.3 days in 2013 (p < 0.001). The average monthly cost of antimicrobials decreased 46.9% from US$30,146.8 in 2011 to US$16,021.3 in 2013 (p < 0.001). Total intravenous antimicrobial DDDs per 100 bed-days of the inpatients were 66.9, 54.1 and 48.4 in 2011, 2012 and 2013, respectively. A total of 18.6 DDDs per 100 bed-days of inpatients (27.7%) decreased from 2011 to 2013. By comparing data in 2013 to those in 2011, the ASP reduced antimicrobial resistance of Gram-positive bacteria (p = 0.013), Gram-negative bacteria (p < 0.001), and predominant species (all p < 0.05). The yearly mortality also decreased from 1.3% in 2011 to 1.1% in 2012 and 1.0% in 2013.
The ASP with a culture-guided de-escalation of antibiotics successfully reduced length of stay, mortality, the cost of antimicrobials, DDDs, and antimicrobial resistance rate, and that is highly recommended for local hospitals.
我们旨在报告一项以临床有意义的培养物为指导的抗菌药物管理计划（ASP）在医院中的实施情况，以评估其在药物、微生物、经济和结果方面的效果。
对 2012 年 1 月 1 日开始实施的抗菌药物限制政策进行了为期 3 年的队列研究。在当地医院实施了以培养物指导的抗生素降阶梯的 ASP。计算并评估了实施 ASP 前后所有住院患者的抗菌药物费用、限定日剂量（DDD）、抗菌药物敏感性和转归。
住院患者的平均每月住院时间从 2011 年的 7.8±0.5 天减少到 2013 年的 6.9±0.3 天（p<0.001）。2011 年抗菌药物费用为 30146.8 美元，2013 年减少至 16021.3 美元，降幅为 46.9%（p<0.001）。2011 年、2012 年和 2013 年每 100 个住院床位的总静脉用抗菌药物 DDD 分别为 66.9、54.1 和 48.4。2011 年至 2013 年，每 100 个住院床位的 DDD 减少了 18.6（27.7%）。与 2011 年相比，2013 年 ASP 降低了革兰阳性菌（p=0.013）、革兰阴性菌（p<0.001）和主要菌属（均 p<0.05）的抗菌药物耐药率。年死亡率也从 2011 年的 1.3%降至 2012 年的 1.1%和 2013 年的 1.0%。
以培养物指导的抗生素降阶梯的 ASP 成功地缩短了住院时间、降低了死亡率、抗菌药物费用、DDD 和抗菌药物耐药率，这在当地医院中是非常值得推荐的。
