The impact of antimicrobial stewardship program implementation at four tertiary private hospitals: results of a five-years pre-post analysis
The impact of antimicrobial stewardship program implementation at four tertiary private hospitals: results of a five-years pre-post analysis
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DOI：
10.1186/s13756-020-00751-4
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发表时间：
2020-06-29
影响因子：
5.5
通讯作者：
Al Subaie, Maha
中科院分区：
文献类型：
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作者：
Al-Omari, Awad;Al Mutair, Abbas;Al Subaie, Maha
背景抗菌药物管理(AMS)计划已被证明可以减少抗菌素耐药性(AMR)和卫生保健相关感染(HAI)的出现，并节省与不适当的抗菌药物使用相关的卫生保健费用。这项研究的主要目标是比较AMS计划实施前后使用限定日剂量(DDD)和抗生素直接成本的抗菌剂的消耗和成本。第二个目标是确定在AMS计划实施前后HAI[艰难梭菌(艰难梭菌)、呼吸机相关肺炎(VAP)和中心线相关血流感染(CLABSI)]的发生率。方法这是一项事前、事后的准实验研究。成人住院患者在积极的AMS ARM下以前瞻性的方式登记，并与AMS实施之前在相同单元住院的历史患者进行比较。研究是在沙特阿拉伯两个城市的四家三级私立医院进行的。成年住院患者如果服用10种限制性广谱抗生素中的任何一种(亚胺培南/西司他丁、哌拉西林/他唑巴坦、粘菌素、替吉环素、头孢吡肟、美罗培南、环丙沙星、莫西沙星、替考拉宁和利奈唑胺)，则在AMS前和AMS后ARM下登记。结果共招募409,403名受试者，其中79,369名为AMS前对照组，330,034名为AMS后组。从2016年1月至2019年6月，所有目标广谱抗菌药的平均DDDS消耗量低于AMS前这些药物的DDDS使用量(每1000人日233vs320 DDDS，p=0.689)。抗菌药物支出在该计划的第一年减少了28.45%，并在随后几年保持相对稳定，总累计节省的成本估计为6,286,929瑞典法郎，可忽略不计的开支为505,115瑞典法郎(p=0.648)。与医疗保健相关的感染率。实施AMS后，艰难梭菌、VAP和CLABSI均显著下降(与2019年相比，2015年HAIS的发病率：Forc。艰难杆菌，94对13，p=0.024；VAP，24对6，p=0.001；CLABSI，17对1，p=0.000)。结论HMG医疗机构实施AMS计划，减少了抗菌药物的使用和成本，降低了医疗卫生相关感染的发生率。
Background Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the consumption and cost of antimicrobial agents using defined daily dose (DDD) and direct cost of antibiotics before and after the AMS program implementation. Secondary objective was to determine the rate of HAIs [Clostridium difficile(C. difficile), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLABSI) before and after the AMS program implementation. Methods This is a pre-post quasi-experimental study. Adult inpatients were enrolled in a prospective fashion under the active AMS arm and compared with historical inpatients who were admitted to the same units before the AMS implementation. Study was conducted at four tertiary private hospitals located in two cities in Saudi Arabia. Adult inpatients were enrolled under the pre- AMS arm and post- AMS arm if they were on any of the ten selected restricted broad-spectrum antibiotics (imipenem/cilastatin, piperacillin/tazobactam, colistin, tigecycline, cefepime, meropenem, ciprofloxacin, moxifloxacin, teicoplanin and linezolid). Results A total of 409,403 subjects were recruited, 79,369 in the pre- AMS control and 330,034 in the post- AMS arm. Average DDDs consumption of all targeted broad-spectrum antimicrobials from January 2016 to June 2019 post- AMS launch was lower than the DDDs use of these agents pre- AMS (233 vs 320 DDDs per 1000 patient-days,p = 0.689). Antimicrobial expenditures decreased by 28.45% in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at S.R. 6,286,929 and negligible expenses of S.R. 505,115 (p = 0.648). Rates of healthcare associated infections involvingC. difficile, VAP, and CLABSI all decreased significantly after AMS implementation (incidence of HAIs in 2015 compared to 2019: forC. difficile, 94 vs 13,p = 0.024; for VAP, 24 vs 6,p = 0.001; for CLABSI, 17 vs 1,p = 0.000; respectively). Conclusion Implementation of AMS program at HMG healthcare facilities resulted in reduced antimicrobials use and cost, and lowered incidence of healthcare associated infections.