Impact of the Antimicrobial Stewardship Team Intervention Focusing on Changes in Prescribing Trends and the Rate of Carbapenem-resistant P. aeruginosa
Impact of the Antimicrobial Stewardship Team Intervention Focusing on Changes in Prescribing Trends and the Rate of Carbapenem-resistant P. aeruginosa
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DOI：
10.1248/yakushi.21-00202
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发表时间：
2022-01-01
影响因子：
0.3
通讯作者：
Sasaki, Tadanori
中科院分区：
文献类型：
--
作者：
Naito, Yuika;Maeda, Masayuki;Sasaki, Tadanori
抗菌药物管理（AS）干预策略是促进适当使用抗生素的关键过程，从而防止不必要的延长治疗和减少抗菌药物耐药性（AMR）。虽然通过AS干预限制不必要的碳青霉烯类药物使用被推测可以降低AMR，但缺乏AS团队（AST）干预对碳青霉烯类耐药铜绿假单胞菌（CRPA）有效性的具体数据。因此，本研究旨在评价我们的AS策略对碳青霉烯类药物使用和CRPA的影响。AS干预策略于2017年7月启动，包括对碳青霉烯使用的日常审计和反馈。我们评估了4年的处方趋势，包括转换为其他抗菌药物的比率，CRPA的比率以及AST干预开始前后所需的治疗天数。与干预后相比，干预前改用窄谱抗生素和停止碳青霉烯治疗的比例显著较高。(7.0%对比14.5%; p< 0.001; 54.1%对比50.9%; p= 0.027）。然而，在AST干预开始之前和之后，CRPA的比率没有显著差异。此外，没有发现消费和阻力率之间的相关性（Pearson的r = 0.123）。我们的研究结果表明，这是非常重要的AST，以促进降级，减少不必要的使用，而过程和结果的指标，而不是抗菌药物的消耗和耐药率的组合需要评估的AS计划。
Antimicrobial stewardship (AS) intervention strategy is a critical process in promoting appropriate antibiotic use, thus preventing unnecessarily prolonged therapy and reducing antimicrobial resistance (AMR) . Although limiting unnecessary carbapenem use by AS intervention is speculated to reduce AMR, there is a lack of specific data on the efficacy of AS team (AST) intervention regarding carbapenem-resistant Pseudomonas aeruginosa (CRPA) . Consequently, this study aimed to evaluate the impact of our AS strategy on carbapenem use and CRPA. The AS intervention strategy was launched in July 2017 and consisted of daily audits and feedback on carbapenem use. We evaluated the 4-year prescription trend, including the rate of switching to other antimicrobials, and the rate of CRPA and the days of therapy required prior to and after the beginning of the AST intervention. The rate of switching to narrow-spectrum antibiotics and the discontinuation of carbapenem treatment were significantly higher in the pre-intervention period compared with the post-intervention period. (7.0% vs. 14.5%; p< 0.001; 54.1% vs. 50.9%; p= 0.027). However, there were no significant differences in the rate of CRPA prior to and after the beginning of the AST intervention. Furthermore, there was no correlation found between consumption and resistance rate (Pearson's r = 0.123) . Our results suggest that it is extremely important for AST to promote de-escalation and reduce unnecessary use, while the combination of process and outcome indicators other than antimicrobial consumption and resistance rate are required for the evaluation of the AS programs.