Vol.67 No.1 January 2019
Antimicrobial stewardship program
1)Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, Japan
2)Division of Pharmacy, Tokyo Metropolitan Children's Medical Center
3)Division of Microbiology Laboratory, Tokyo Metropolitan Children's Medical Center
4)Department of Pediatrics, Niigata University
Abstract
The antimicrobial stewardship program (ASP) refers to an intervention used in healthcare facilities to deal with antimicrobial resistance to currently available antibiotics. The Tokyo Metropolitan Children's Medical Center developed an independent sub-committee to systematically implement an ASP. First, antimicrobial consumption was evaluated by measuring Days of Therapy (DOT) per 1,000 patient-days, to explore possible targets for interventions. Process metrics and outcome metrics were also measured for evaluation, analysis and planning of further interventions. Prospective-audit was implemented for post-prescriptive reporting of specific antimicrobial agents, in order to reduce unnecessary usage. After reduced usage was achieved, post-prescriptive reporting was switched to pre-authorization of restricted antimicrobial agents. Successful reduction in the usage of broad-spectrum antimicrobials, including oral cephalosporins, macrolides and quinolones, was achieved. Meanwhile, the reduced infection-related mortality also confirmed the usefulness of our ASP. The microbiology laboratory introduced restrictive reporting of susceptibility results, optimization of testing indications, and molecular testing. The pharmacy implemented minimizing the length of the drug formulary and introduced a manual for drug dosage and administration, according to the global standard and therapeutic drug monitoring. Interventions for the local populations and medical professionals were also undertaken, with lectures, leaflets, posters and web-based information. All the activities were officially reported to the committee of the hospital, with monthly data on the DOTs. At the commencement of an ASP, confronting resistance by staff is common. An ASP is crucial to tackle antimicrobial resistance, which the majority of medical professionals would agree with over time. The key points, for infectious disease specialists, to implementing a successful ASP are, establishment of trust, avoidance of tempestuous relationships, a systematic rather than individual approach, and commitment to antimicrobial resistance as infectious disease specialists.
Key word
antibiotic, antimicrobial stewardship program, antimicrobial resistance, pre-authorization, prospective audit and feedback
Received
May 21, 2018
Accepted
July 11, 2018
Jpn. J. Chemother. 67 (1): 23-28, 2019
