Pediatr Infect Dis J. 2018 Feb;37(2):164-168. doi: 10.1097/INF.0000000000001746.
The Japanese government's goal for the reduction of antimicrobial consumption is two-thirds of the 2013 rate by 2020. While the antimicrobial stewardship programs (ASPs) are essential in health care facilities, ASP data on pediatric hematology-oncology and hematopoietic stem cell transplant (HSCT) patients are limited. Our aim was to evaluate the impact of restrictive and persuasive ASP on immunocompromised children.
The ASP for hematology-oncology and HSCT patients at Tokyo Metropolitan Children's Medical Center was assessed. Phase 1 was a postprescriptive review of carbapenem conducted between April 2010 and September 2011. Phase 2 consisted of the preauthorization of carbapenem, prospective audit with feedback, a weekly luncheon meeting among physicians, consensus on febrile neutropenia management, and implementation of viral molecular diagnostics between October 2011 and September 2015. Both phases were compared for day-of-therapy per 1,000 patient-days, cost of intravenous antimicrobial agents, average hospitalization duration, all-cause mortality, infection-related mortality at 30 days, and appropriateness of empirical treatment of bacteremia.
The ASP did not differ from phase 1 to phase 2 in terms of average hospitalization length, mortality rate, or appropriateness of empirical treatment for bacteremia. Day-of-therapies of cefepime, piperacillin/tazobactam, meropenem, vancomycin, liposomal amphotericin B, and fosfluconazole decreased by 20%, 45%, 57%, 38%, 85% and 44%, respectively (P < 0.05). The total cost of antibiotic and antifungal agents decreased by 27%, for a savings of $59,905 USD annually.
Restrictive and persuasive ASP in the hematology-oncology ward and the HSCT unit safely decreased the use of antibacterial and antifungal agents.
日本政府的目标是到 2020 年将抗菌药物的使用量减少到 2013 年的三分之二。抗菌药物管理计划（ASPs）在医疗机构中至关重要，但儿科血液肿瘤学和造血干细胞移植（HSCT）患者的 ASP 数据有限。我们的目的是评估限制和说服性 ASP 对免疫功能低下儿童的影响。
评估了东京都儿童医疗中心血液肿瘤学和 HSCT 患者的 ASP。第 1 阶段是 2010 年 4 月至 2011 年 9 月期间对碳青霉烯类药物进行的处方后审查。第 2 阶段包括碳青霉烯类药物的预授权、前瞻性审核与反馈、医生每周午餐会议、发热性中性粒细胞减少症管理共识以及病毒分子诊断的实施，时间为 2011 年 10 月至 2015 年 9 月。比较了两个阶段每千名患者治疗日的治疗日数、静脉用抗菌药物的成本、平均住院时间、总死亡率、30 天内感染相关死亡率以及菌血症经验性治疗的适宜性。
在平均住院时间、死亡率或菌血症经验性治疗的适宜性方面，ASP 从第 1 阶段到第 2 阶段没有差异。头孢吡肟、哌拉西林/他唑巴坦、美罗培南、万古霉素、脂质体两性霉素 B 和氟康唑的治疗日分别减少了 20%、45%、57%、38%、85%和 44%（P < 0.05）。抗生素和抗真菌药物的总费用减少了 27%，每年节省 59905 美元。
血液肿瘤学病房和 HSCT 病房的限制和说服性 ASP 安全地减少了抗菌和抗真菌药物的使用。
