Vol.67 No.5 September 2019
Efficacy of intervention by the antimicrobial stewardship team on days 5 and 14 after the start of meropenem administration
1)Department of Pharmacy, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi, Chuo-ku, Tokyo, Japan
2)Department of Infectious Diseases Department, St. Luke's International Hospital, St. Luke's International University
3)Department of Clinical Laboratory, St. Luke's International Hospital, St. Luke's International University
4)Department of Infection Control, Quality Improvement Center, St. Luke's International Hospital, St. Luke's International University
Abstract
Eradication of multidrug-resistant bacteria is a major medical challenge, and reports show active involvement of an antimicrobial stewardship team (AST) is associated with improved antibiotic susceptibility rates and shorter hospital lengths of stay. At St. Luke's International Hospital, meropenem (MEPM) is the only carbapenem antibiotic available in the hospital formulary. In June 2010, we introduced a program requiring authorization by infectious disease physicians for MEPM prescriptions. Although the MEPM susceptibility rate against Pseudomonas aeruginosa improved thereafter, it has decreased again in recent years. Therefore, in August 2016, an AST was formed to conduct a prospective audit and feedback on MEPM use. The AST assessed the appropriateness of MEPM administration on days 5 and 14 of therapy, and forwarded its recommendations to the attending physicians. The purpose of this retrospective study was to evaluate the efficacy of the intervention by the AST.
All patients (232 in total) who received MEPM from April 2013 to September 2017 were included in the study. The primary endpoints were days of therapy (DOT; /1,000 bed days) and the MEPM susceptibility rate against P. aeruginosa, which were evaluated every 6 months.
The number of interventions on days 5 and 14 were 205 and 83, respectively. The acceptance rate of the AST recommendations by the attending physicians was 84.4%. DOT changed from 27.2-32.0 before the AST intervention to 23.2-25.2 after the AST intervention (p = 0.065). The MEPM susceptibility rate against P. aeruginosa changed from 78-89% before the AST intervention to 79-90% after the AST intervention.
In this study, a prospective audit and feedback intervention on days 5 and 14 in addition to preauthorization failed to improve the DOTs and MEPM susceptibility rate of P. aeruginosa. However, recommendations made by the AST were well accepted and contributed to the optimization of treatment for individual patients.
Key word
antimicrobial stewardship team, meropenem, days of therapy, antimicrobial use density
Received
December 10, 2018
Accepted
April 24, 2019
Jpn. J. Chemother. 67 (5): 583-590, 2019
