Department of Infectious Diseases, Aso Iizuka Hospital, Fukuoka, Japan; Clinical Research Support Office, Aso Iizuka Hospital, Fukuoka, Japan; Infection Control Center, Aso Iizuka Hospital, Fukuoka, Japan.
Department of Pharmacy, Aso Iizuka Hospital, Fukuoka, Japan; Infection Control Center, Aso Iizuka Hospital, Fukuoka, Japan.
J Infect Chemother. 2021 Mar;27(3):439-444. doi: 10.1016/j.jiac.2020.10.006. Epub 2020 Oct 29.
There is an insufficient number of infectious disease (ID) physicians in Japan. Hence, we considered a strategy to implement antimicrobial stewardship under these resource-limited settings.
We compared carbapenem consumption, measured as days of therapy per 100 patient-days, between 24-month baseline and 12-month intervention periods. During the intervention period, an ID physician provided daily advises to prescribers against prolonged carbapenem use (≥14 days). Additionally, we sent all doctors a table containing the weekly point prevalence aggregate of carbapenem use of each department for 7-13 and ≥ 14 days via e-mail.
Among the 1241 carbapenem courses during the intervention period, the ID physician provided a total of 96 instances of feedback regarding carbapenem use for ≥14 days, with an acceptance rate of 76%. After the initiation of the intervention, the trend in monthly carbapenem consumption changed (coefficient: -0.62; 95% CI: -1.15 to -0.087, p = 0.024), and its consumption decreased (coefficient: -0.098; 95% CI: -0.16 to -0.039, p = 0.002) without an increase in the consumption of broad-spectrum antimicrobials or in-hospital mortality. Interestingly, the monthly number of carbapenem courses, but not the duration of carbapenem use, significantly decreased (coefficient: -3.02; 95% CI: -4.63 to -1.42, p = 0.001). The carbapenem-related annual estimated savings after the intervention was $83,745, with a 22% cost reduction.
Our ID physician-led daily intervention with weekly feedback regarding long-term carbapenem use was effective in reducing antimicrobial consumption. Such feedback may be useful in changing the prescribing behavior and promoting appropriate antimicrobial usage even in resource-limited settings.
日本感染病（ID）医师的人数不足。因此，我们考虑在资源有限的情况下实施抗菌药物管理策略。
我们比较了 24 个月基线期和 12 个月干预期的碳青霉烯类药物消耗情况，以治疗日数/100 患者日数表示。在干预期间，一名 ID 医师每天向开具者提供有关避免长期使用碳青霉烯类药物（≥14 天）的建议。此外，我们通过电子邮件向所有医生发送了一张包含每个科室每周碳青霉烯类药物使用点流行率汇总表，时间为 7-13 天和≥14 天。
在干预期间的 1241 例碳青霉烯类药物疗程中，ID 医师总共提供了 96 次关于碳青霉烯类药物使用≥14 天的反馈，接受率为 76%。干预开始后，每月碳青霉烯类药物消耗的趋势发生了变化（系数：-0.62；95%置信区间：-1.15 至-0.087，p=0.024），其消耗量减少（系数：-0.098；95%置信区间：-0.16 至-0.039，p=0.002），而广谱抗菌药物的消耗或院内死亡率没有增加。有趣的是，碳青霉烯类药物疗程的月数，而不是碳青霉烯类药物使用的持续时间，显著减少（系数：-3.02；95%置信区间：-4.63 至-1.42，p=0.001）。干预后，碳青霉烯类药物相关的年估计节省额为 83745 美元，成本降低了 22%。
我们的 ID 医师主导的每日干预措施，加上每周关于长期碳青霉烯类药物使用的反馈，有效减少了抗菌药物的消耗。即使在资源有限的情况下，这种反馈也可能有助于改变处方行为，促进适当的抗菌药物使用。
