Mahmoudi Laleh, Sepasian Alireza, Firouzabadi Dena, Akbari Ali
Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.
Risk Manag Healthc Policy. 2020 Sep 23;13:1701-1709. doi: 10.2147/RMHP.S265407. eCollection 2020.
Inappropriate use of antimicrobials (AM) is a major concern worldwide that leads to the propagation of antimicrobial resistance (AMR). In addition to its clinical implications, AMR imposes an economic burden on communities, especially developing countries with more infectious diseases and less available resources. Antimicrobial stewardship programs (ASPs) have been found to be effective in reducing AMR. This study was designed to evaluate the effect of implementing an ASP in reducing AM consumption, its economic burden, and AMR as a consecutive result.
Consumption of caspofungin, amphotericin B, voriconazole, colistin, linezolid, vancomycin, and carbapenems was compared in a prospective cross-sectional study between two time periods introduced as pre- and post-ASP. Drug use density presented as anatomical therapeutic chemical (ATC)/defined daily doses (DDD) and normalized per 1000 bed days, cost savings, and AMR patterns were evaluated.
A total of 9400 AM prescriptions were analyzed during a 2-year period. Consumption measured in DDD/1000 bed days dropped by 24.8, 25.0, 35.3, 47.0, 39.2, 10.5, and 23.2 percent for amphotericin B, caspofungin, colistin, voriconazole, meropenem, imipenem, and vancomycin, respectively. Linezolid consumption increased by 26.8% after implementing ASP. The expenditure of target AMs in the average value of USD decreased by 41.3% after the intervention compared to the time before using ASP (-value=0.001). Implementing ASP also increased AM susceptibility of , while the susceptibility of methicillin-resistant did not change significantly.
The results of this study suggest that establishment of ASP can lead to a reduction in improper administration of AMs and their expenditure resulting in economic benefit and lowering AMR at hospitals with minimum resources. Clinical pharmacists' role was critical to the success of this ASP and was uniquely empowered at our center.
抗菌药物的不当使用是全球主要关注的问题，它导致了抗菌药物耐药性（AMR）的传播。除了其临床影响外，AMR还给社区带来经济负担，尤其是在传染病较多且资源较少的发展中国家。抗菌药物管理计划（ASP）已被证明在降低AMR方面是有效的。本研究旨在评估实施ASP在减少抗菌药物消耗、其经济负担以及作为连续结果的AMR方面的效果。
在一项前瞻性横断面研究中，比较了卡泊芬净、两性霉素B、伏立康唑、黏菌素、利奈唑胺、万古霉素和碳青霉烯类药物在引入ASP前后两个时间段的消耗情况。以解剖治疗化学（ATC）/限定日剂量（DDD）表示并按每1000床日进行标准化的药物使用密度、成本节约情况以及AMR模式进行了评估。
在两年期间共分析了9400份抗菌药物处方。以DDD/1000床日衡量的消耗，两性霉素B、卡泊芬净、黏菌素、伏立康唑、美罗培南、亚胺培南和万古霉素分别下降了24.8%、25.0%、35.3%、47.0%、39.2%、10.5%和23.2%。实施ASP后利奈唑胺的消耗增加了26.8%。与使用ASP之前相比，干预后目标抗菌药物的平均支出以美元计下降了41.3%（P值=0.001）。实施ASP还提高了[具体细菌名称]的抗菌药物敏感性，而耐甲氧西林[具体细菌名称]的敏感性没有显著变化。
本研究结果表明，建立ASP可导致抗菌药物的不当使用及其支出减少，从而在资源最少的医院产生经济效益并降低AMR。临床药师的作用对该ASP的成功至关重要，并且在我们中心具有独特的权力。
