Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Infectious Diseases, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea.
Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Antibiotic Support Team, Asan Medical Center, Seoul, South Korea.
J Hosp Infect. 2023 Oct;140:132-138. doi: 10.1016/j.jhin.2023.07.019. Epub 2023 Aug 5.
The development of carbapenem-resistant Gram-negative bacilli (CR-GNB) is largely favoured by indiscriminate and prolonged carbapenem use, which is a significant contributing factor.
To evaluate the impact of two carbapenem antibiotic stewardship programme interventions on both carbapenem prescriptions and the clinical isolation rates of CR-GNBs, using interrupted time-series analysis.
A time-series analysis was performed using data for carbapenem usage from a tertiary hospital in South Korea from January 2017 to July 2022. Two carbapenem antibiotic stewardship programme interventions were implemented sequentially: (i) a prospective audit and feedback (PAF) from November 2018 to April 2020 (intervention 1), and (ii) preauthorization from May 2020 to August 2020 (intervention 2). Monthly carbapenem usage and incidence of CR-GNB before and after each intervention were compared using an autoregressive integrated moving average model.
Implementation of PAF resulted in a significant reduction in carbapenem consumption, followed by an additional decrease after the preauthorization was implemented. The incidence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae increased after intervention 1, but there was a significant change from an increasing trend to a stationary trend after intervention 2. The incidence of carbapenem-resistant Pseudomonas aeruginosa, which had increased during the baseline period, became stationary after intervention 1. A significant decrease was observed in the incidence of carbapenem-resistant Acinetobacter baumannii during the implementation of intervention 1 and 2.
This study emphasizes the importance of adopting comprehensive antibiotic management and rigorous infection control to prevent infections caused by antibiotic-resistant bacteria.
碳青霉烯类耐药革兰氏阴性杆菌（CR-GNB）的产生在很大程度上受到碳青霉烯类药物的无差别和长期使用的推动，这是一个重要的促成因素。
使用中断时间序列分析评估两种碳青霉烯类抗生素管理计划干预对碳青霉烯类药物处方和 CR-GNB 临床分离率的影响。
对韩国一家三级医院 2017 年 1 月至 2022 年 7 月的碳青霉烯类药物使用数据进行时间序列分析。先后实施了两项碳青霉烯类抗生素管理计划干预：（i）2018 年 11 月至 2020 年 4 月的前瞻性审核和反馈（干预 1），（ii）2020 年 5 月至 8 月的预授权（干预 2）。使用自回归积分移动平均模型比较干预前后每月碳青霉烯类药物使用量和 CR-GNB 的发生率。
实施 PAF 导致碳青霉烯类药物消耗显著减少，随后在实施预授权后进一步减少。碳青霉烯类耐药大肠埃希菌和肺炎克雷伯菌的发生率在干预 1 后增加，但在干预 2 后，从上升趋势变为稳定趋势。在基线期间增加的碳青霉烯类耐药铜绿假单胞菌在干预 1 后变为稳定。在实施干预 1 和 2 期间，碳青霉烯类耐药鲍曼不动杆菌的发生率显著下降。
本研究强调了采取综合抗生素管理和严格感染控制措施以预防抗生素耐药菌感染的重要性。
