Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan.
Division of Infection Control and Prevention, Shimane University Hospital, Izumo, Shimane, Japan.
Sci Rep. 2022 Sep 7;12(1):15135. doi: 10.1038/s41598-022-19374-3.
Antibiotic stewardship programs reduce antibiotic use without negative clinical outcomes. However, epidemiological data describing the relationship between implementing antimicrobial stewardship and candidemia incidence are scarce. This study aimed to evaluate the effect of antibiotic stewardship on the incidence of hospital acquired candidemia. We conducted a retrospective study from April 2017 to September 2020. We reviewed patients that were treated with three broad-spectrum antipseudomonal agents: carbapenem, tazobactam/piperacillin, and cefepime. Monthly aggregated hospital antimicrobial consumption was measured as days of therapy (DOTs) per 1000 patient-days, and the monthly incidence of hospital acquired candidemia was recorded. The median monthly carbapenem-DOTs during pre-intervention and intervention were 28.4 and 10.0, respectively. Time-series analysis showed significant level changes after intervention: - 10.0 DOTs (p = 0.02). There was a downward trend in the monthly carbapenem-DOTs after intervention. The median hospital-acquired candidemia incidence was 0.17 and 0.08 per 1000 patient-days during pre-intervention and intervention periods, respectively. Time-series analysis showed a significant level change after intervention (- 0.16 per 1000 patient-days; p = 0.048). The trend in the incidence of hospital-acquired candidemia did not significantly change between pre-intervention and intervention. Decreased broad-spectrum antibiotic use (particularly carbapenem) by our antimicrobial stewardship term may reduce hospital-acquired candidemia incidences.
抗生素管理项目可减少抗生素的使用而不会产生负面的临床结果。然而，描述实施抗菌药物管理与念珠菌血症发病率之间关系的流行病学数据却很少。本研究旨在评估抗生素管理对医院获得性念珠菌血症发病率的影响。我们进行了一项回顾性研究，时间范围为 2017 年 4 月至 2020 年 9 月。我们回顾了接受三种广谱抗假单胞菌药物治疗的患者：碳青霉烯类、他唑巴坦/哌拉西林和头孢吡肟。每月汇总的医院抗菌药物消耗量以每 1000 个患者日的治疗日数（DOTs）衡量，记录每月医院获得性念珠菌血症的发病率。在干预前和干预期间，每月碳青霉烯类药物的中位数 DOTs 分别为 28.4 和 10.0。时间序列分析显示干预后水平发生显著变化：-10.0 DOTs（p=0.02）。干预后，每月碳青霉烯类药物的使用量呈下降趋势。在干预前和干预期间，每月医院获得性念珠菌血症的发病率中位数分别为 0.17 和 0.08/1000 个患者日。时间序列分析显示干预后水平发生显著变化（-0.16/1000 个患者日；p=0.048）。干预前后，医院获得性念珠菌血症的发病率趋势没有显著变化。我们的抗菌药物管理项目减少了广谱抗生素的使用（尤其是碳青霉烯类药物），可能降低了医院获得性念珠菌血症的发病率。
