Vol.59 No.3 May 2011
Effectiveness of a comprehensive prescription management system for injectable antibacterial agent use: Results of a 5-year heart center study
1)Infection Control Office, Department of Medical Safety Administration, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, Japan
2)Department of Pharmacy, Iwate Medical University Hospital
3)Department of Clinical Laboratory, Iwate Medical University Hospital
4)Department of Laboratory Medicine, School of Medicine, Iwate Medical University
5)Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Science, Iwate Medical University
Abstract
A major 1,051-bed hospital has, promoted appropriate injectable antibacterial agent use through a comprehensive prescription management system since April 2003. It uses unique agent classification, submission of a statement of reasons for the use of each antibacterial level, and prescription history cards with a limited prescription period. Following the system's introduction, the amount of broad-spectrum antibacterials used and the number of drug-resistant bacterial strains detected, cutting the cost of injectable antibacterial agents. To evaluate system effectiveness, we analyzed results at a 115-bed heart center(HC) using the same system since April 2004, one year after its introduction.
The study covered 2003, 2004, and 2008. The antimicrobial use density(AUD) was expressed as defined daily dose per 1,000 patient days. We examined the amount of injectable antibacterials used and corresponding cost, the isolation rate of drug-resistant bacteria including methicillin-resistant Staphylococcus aureus(MRSA), and the change MRSA in prevalence. Before the system was introduced, total antibacterials used at the HC was 377.3±62.1. This decreased significantly in the 5 years following introduction: 299.4±41.2, 261.6±37.4, 310.5±70.6, 295.7±43.1, and 298.7±29.0 (p<0.05). The use of broad-spectrum antibiotics such as carbapenem, quinolone, and fourth-generation cephem decreased significantly compared to before system introduction. The mean monthly MRSA isolation rate (%) decreased from 11.5±3.1 before system introduction to 10.0±3.0, 6.2±2.0, 5.3±2.3, 4.9±2.3, and 3.7±2.2 following introduction, significantly decreasing each year (p<0.05). These reductions, including cost, show the system's effectiveness at both a major hospital and a separate MC and the medium- to long-term benefits of using the system.
Key word
antibiotic stewardship, antimicrobial use density (AUD), drug resistance, use notification policy
Received
November 11, 2010
Accepted
February 14, 2011
Jpn. J. Chemother. 59 (3): 285-292, 2011
