Skip to main content
Log in

Antimicrobial stewardship program directed at broad-spectrum intravenous antibiotics prescription in a tertiary hospital

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The antimicrobial stewardship program (ASP) is a major strategy to combat antimicrobial resistance and to limit its expenditure. We have improved on our existing ASP to implement a sustainable and cost-effective two-stage immediate concurrent feedback (ICF) model, in which the antimicrobial prescription is audited by two part-time infection control nurses at the first stage, followed by “physician ICF” at the second stage. In January 2005, an ASP focused on broad-spectrum intravenous antibiotics was implemented. All in-patients, except from the intensive care, bone marrow transplantation, liver transplantation, pediatric, and private units, being treated with broad-spectrum intravenous antibiotics were included. The compliance to ICF and “physician ICF”, antibiotics usage density measured by expenditure and defined daily doses (DDD) were recorded and analyzed before and after the ASP. The overall conformance rate to antibiotic prescription guidelines was 79.4%, while the conformance to ICF was 83.8%. Antibiotics consumption reduced from 73.06 (baseline, year 2004) to 64.01 (year 2007) per 1,000 patient bed-day-occupancy. Our model can be easily applied even in the clinical setting of limited resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Reference

  1. Smith RD (1999) Antimicrobial resistance: the importance of developing long-term policy. Bull World Health Organ 77:862

    CAS  PubMed  Google Scholar 

  2. Bell JM, Turnidge JD, SENTRY APAC (2002) High prevalence of oxacillin-resistant Staphylococcus aureus isolates from hospitalized patients in Asia-Pacific and South Africa: results from SENTRY antimicrobial surveillance program, 1998–1999. Antimicrob Agents Chemother 46:879–881

    Article  CAS  PubMed  Google Scholar 

  3. Ho PL, Tse WS, Tsang KW, Kwok TK, Ng TK, Cheng VC, Chan RM (2001) Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case-control study. Clin Infect Dis 32:701–707

    Article  CAS  PubMed  Google Scholar 

  4. Ho PL, Yung RW, Tsang DN, Que TL, Ho M, Seto WH, Ng TK, Yam WC, Ng WW (2001) Increasing resistance of Streptococcus pneumoniae to fluoroquinolones: results of a Hong Kong multicentre study in 2000. J Antimicrob Chemother 48:659–665

    Article  CAS  PubMed  Google Scholar 

  5. Ho PL, Que TL, Chiu SS, Yung RW, Ng TK, Tsang DN, Seto WH, Lau YL (2004) Fluoroquinolone and other antimicrobial resistance in invasive pneumococci, Hong Kong, 1995–2001. Emerg Infect Dis 10:1250–1257

    CAS  PubMed  Google Scholar 

  6. Ho PL, Shek RH, Chow KH, Duan RS, Mak GC, Lai EL, Yam WC, Tsang KW, Lai WM (2005) Detection and characterization of extended-spectrum beta-lactamases among bloodstream isolates of Enterobacter spp. in Hong Kong, 2000–2002. J Antimicrob Chemother 55:326–332

    Article  CAS  PubMed  Google Scholar 

  7. Ho PL, Ho AY, Chow KH, Wong RC, Duan RS, Ho WL, Mak GC, Tsang KW, Yam WC, Yuen KY (2005) Occurrence and molecular analysis of extended-spectrum {beta}-lactamase-producing Proteus mirabilis in Hong Kong, 1999–2002. J Antimicrob Chemother. 55(6):840–845

    Article  CAS  PubMed  Google Scholar 

  8. Ho PL, Poon WW, Loke SL, Leung MS, Chow KH, Wong RC, Yip KS, Lai EL, Tsang KW, COMBAT study group (2007) Community emergence of CTX-M type extended-spectrum beta-lactamases among urinary Escherichia coli from women. J Antimicrob Chemother 60:140–144

    Article  CAS  PubMed  Google Scholar 

  9. Ling TK, Ying CM, Lee CC, Liu ZK (2005) Comparison of antimicrobial resistance of Acinetobacter baumannii clinical isolates from Shanghai and Hong Kong. Med Princ Pract 14:338–341

    Article  PubMed  Google Scholar 

  10. Hirakata Y, Matsuda J, Miyazaki Y, Kamihira S, Kawakami S, Miyazawa Y, Ono Y, Nakazaki N, Hirata Y, Inoue M, Turnidge JD, Bell JM, Jones RN, Kohno S, SENTRY Asia-Pacific Participants (2005) Regional variation in the prevalence of extended-spectrum beta-lactamase-producing clinical isolates in the Asia-Pacific region (SENTRY 1998–2002). Diagn Microbiol Infect Dis 52:323–329

    Article  PubMed  Google Scholar 

  11. Smith RD, Coast J (2002) Antimicrobial resistance: a global response. Bull World Health Organ 80:126–133

    PubMed  Google Scholar 

  12. Simonsen GS, Tapsall JW, Allegranzi B, Talbot EA, Lazzari S (2004) The antimicrobial resistance containment and surveillance approach—a public health tool. Bull World Health Organ 82:928–934

    PubMed  Google Scholar 

  13. Marr JJ, Moffet HL, Kunin CM (1988) Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis 157:869–876

    CAS  PubMed  Google Scholar 

  14. Shlaes DM, Gerding DN, John JF Jr, Craig WA, Bornstein DL, Duncan RA, Eckman MR, Farrer WE, Greene WH, Lorian V, Levy S, McGowan JE Jr, Paul SM, Ruskin J, Tenover FC, Watanakunakorn C (1997) Society for healthcare epidemiology of America and infectious diseases society of america joint committee on the prevention of antimicrobial resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 25:584–599

    Article  CAS  PubMed  Google Scholar 

  15. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, Huskins WC, Paterson DL, Fishman NO, Carpenter CF, Brennan PJ, Billeter M, Hooton TM, Society for Healthcare Epidemiology of America, Infectious Diseases Society of America (2007) Infectious diseases society of America and the society for healthcare epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44:159–177

    Article  PubMed  Google Scholar 

  16. Schentag JJ, Ballow CH, Fritz AL, Paladino JA, Williams JD, Cumbo TJ, Ali RV, Galletta VA, Gutfeld MB, Adelman MH (1993) Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious disease division, and the microbiology laboratory. Diagn Microbiol Infect Dis 16:255–264

    Article  CAS  PubMed  Google Scholar 

  17. Fraser GL, Stogsdill P, Dickens JD Jr, Wennberg DE, Smith RP Jr, Prato BS (1997) Antibiotic optimization. An evaluation of patient safety and economic outcomes. Arch Intern Med 157:1689–1694

    Article  CAS  PubMed  Google Scholar 

  18. Gums JG, Yancey RW Jr, Hamilton CA, Kubilis PS (1999) A randomized, prospective study measuring outcomes after antibiotic therapy intervention by a multidisciplinary consult team. Pharmacotherapy 19:1369–1377

    Article  CAS  PubMed  Google Scholar 

  19. Hamilton CD, Drew R, Janning SW, Latour JK, Hayward S (2000) Excessive use of vancomycin: a successful intervention strategy at an academic medical center. Infect Control Hosp Epidemiol 21:42–45

    Article  CAS  PubMed  Google Scholar 

  20. Solomon DH, Van Houten L, Glynn RJ, Baden L, Curtis K, Schrager H, Avorn J (2001) Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. Arch Intern Med 161:1897–1902

    Article  CAS  PubMed  Google Scholar 

  21. Kumana CR, Ching TY, Kong Y, Ma EC, Kou M, Lee RA, Cheng VC, Chiu SS, Seto WH (2001) Curtailing unnecessary vancomycin usage in a hospital with high rates of methicillin resistant Staphylococcus aureus infections. Br J Clin Pharmacol 52:427–432

    Article  CAS  PubMed  Google Scholar 

  22. Carling P, Fung T, Killion A, Terrin N, Barza M (2003) Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 24:699–706

    Article  PubMed  Google Scholar 

  23. Seto WH, Ching TY, Kou M, Chiang SC, Lauder IJ, Kumana CR (1996) Hospital antibiotic prescribing successfully modified by ‘immediate concurrent feedback’. Br J Clin Pharmacol 41:229–234

    Article  CAS  PubMed  Google Scholar 

  24. Ho PL, Cheng JC, Ching PT, Kwan JK, Lim WW, Tong WC, Wu TC, Tse CW, Lam R, Yung R, Seto WH, Consensus Meeting Group on Antimicrobial Stewardship Programme (2006) Optimising antimicrobial prescription in hospitals by introducing an antimicrobial stewardship programme in Hong Kong: consensus statement. Hong Kong Med J 12:141–148

    CAS  PubMed  Google Scholar 

  25. Tumbarello M, Sanguinetti M, Montuori E, Trecarichi EM, Posteraro B, Fiori B, Citton R, D’Inzeo T, Fadda G, Cauda R, Spanu T (2007) Predictors of mortality in patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Enterobacteriaceae: importance of inadequate initial antimicrobial treatment. Antimicrob Agents Chemother 51:1987–1994

    Article  CAS  PubMed  Google Scholar 

  26. Bru JP, Michallet M, Legrand C, Swierz P, Stahl JP, Leautet JB, Sotto JJ, Hollard D, Micoud M (1986) A prospective randomized study comparing the efficacy of Timentin alone or in combination with amikacin in the treatment of febrile neutropenic patients. J Antimicrob Chemother 17(Suppl C):203–209

    PubMed  Google Scholar 

  27. Burke JP (1998) Antibiotic resistance—squeezing the balloon? JAMA 1998(280):1270–1271

    Article  Google Scholar 

  28. Piroth L, Aubé H, Doise JM, Vincent-Martin M (1998) Spread of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: are beta-lactamase inhibitors of therapeutic value? Clin Infect Dis 27:76–80

    Article  CAS  PubMed  Google Scholar 

  29. Rice LB, Lakticová V, Helfand MS, Hutton-Thomas R (2004) In vitro antienterococcal activity explains associations between exposures to antimicrobial agents and risk of colonization by multiresistant enterococci. J Infect Dis 190:2162–2166

    Article  CAS  PubMed  Google Scholar 

  30. Rice LB, Eckstein EC, DeVente J, Shlaes DM (1996) Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 23:118–124

    CAS  PubMed  Google Scholar 

  31. Lan CK, Hsueh PR, Wong WW, Fung CP, Lau YT, Yeung JY, Young GT, Su CC (2003) Association of antibiotic utilization measures and reduced incidence of infections with extended-spectrum beta-lactamase-producing organisms. J Microbiol Immunol Infect 36:182–186

    CAS  PubMed  Google Scholar 

  32. Ho PL, Wong RC, Yip KS, Loke SL, Leung MS, Mak GC, Chow FK, Tsang KW, Que TL, COMBAT study group (2007) Antimicrobial resistance in Escherichia coli outpatient urinary isolates from women: emerging multidrug resistance phenotypes. Diagn Microbiol Infect Dis 59:439–445

    Article  CAS  PubMed  Google Scholar 

  33. Rahal JJ, Urban C, Horn D, Freeman K, Segal-Maurer S, Maurer J, Mariano N, Marks S, Burns JM, Dominick D, Lim M (1998) Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA 280:1233–1237

    Article  CAS  PubMed  Google Scholar 

  34. Allegranzi B, Luzzati R, Luzzani A, Girardini F, Antozzi L, Raiteri R, Di Perri G, Concia E (2002) Impact of antibiotic changes in empirical therapy on antimicrobial resistance in intensive care unit-acquired infections. J Hosp Infect 52:136–140

    Article  CAS  PubMed  Google Scholar 

  35. Eagye KJ, Kuti JL, Nicolau DP (2009) Risk factors and outcomes associated with isolation of meropenem high-level-resistant Pseudomonas aeruginosa. Infect Control Hosp Epidemiol 30:746–752

    Article  PubMed  Google Scholar 

  36. Falagas ME, Kopterides P (2006) Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. J Hosp Infect 64:7–15

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to V. C. C. Cheng.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cheng, V.C.C., To, K.K.W., Li, I.W.S. et al. Antimicrobial stewardship program directed at broad-spectrum intravenous antibiotics prescription in a tertiary hospital. Eur J Clin Microbiol Infect Dis 28, 1447–1456 (2009). https://doi.org/10.1007/s10096-009-0803-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-009-0803-8

Keywords

Navigation