さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense a ID pharmacist. Another face is an investor.

Effectiveness of an Antimicrobial Stewardship Program in Critical Care: A Before-and-After Study.

AACに発表された、バロセロナにある総合病院のICUによるASPの効果。

Abstract

We evaluated the use of antimicrobials expressed as defined daily doses (DDDs) per 1,000 patient days and days of therapy (DOT) per 100 occupied bed-days in a intensive care unit (UCI) of a general hospital in Barcelona, Spain, before and after implementation of an antimicrobial stewardship (AMS) program (2007-2010 versus 2011-2015). The quarterly costs of antimicrobials used in the ICU and its weight in the overall hospital costs of antimicrobials were calculated. The effect of the applied AMS program on DDDs and DOT time series data was analyzed by means of intervention time series analysis. A total of 5,002 patients were included (1,971 for the first [before] period and 3,031 for the second [after] period). The percentage of patients treated with one or more antimicrobials decreased from 88.6% to 77.2% (P< 0.001). DDDs decreased from 246.8 to 192.3 (mean difference -54.5, P = 0.001) and DOT from 66.7 to 54.6 (mean difference -12.1, P = 0.066). The mean cost per trimester decreased from 115,543[euro] to 73,477[euro] (mean difference -42,065.4[euro], P< 0.001) and the percentage of ICU antimicrobials cost with respect to the total cost of hospital antimicrobials decreased from 28.5% to 22.8% (mean difference -5.59, P = 0.023). Implementation of an AMS program in the ICU was associated with a marked reduction of the use of antimicrobials, with cost savings close to one million euros since its implementation. An AMS program can have a significant impact on optimizing antimicrobial use in critical care practice.

 

 

  1. Antimicrobial stewardship (AMS) program.

  2. Between January 1 and March 31, 2011, a program for optimizing the use of antimicrobials

  3. was implemented in the hospital.

  4. Prior to the application of the AMS program, each attending physician or medical team

  5. decided on which antimicrobials had to be administered to their patients and the

  6. duration of treatment. No restriction programs for the use of antimicrobials have been

  7. implemented before 2011. In the hospital and in the ICU, there were some guidelines

  8. for the use of antibiotics but these recommendations have not been subjected to

  9. audits or assessments of adherence.

  10. The AMS program included the following characteristics:

  11. a) establishment of a multidisciplinary working group with specialists in

  12. infectious diseases, pharmacy, microbiology, and intensive care medicine who were

  13. responsible for the design and implementation of the AMS program;

  14. b) development of a computer application for the specific prescription of antimicrobials which was

  15. added to the patient’s computerized medical record;

  16. c) selection of 10 antimicrobial agents, which due to their greater environmental and economic impact, underwent special control measures, including the need to justify their indications in writing

  17. through the application form of the program, compulsory detailed information of the

  18. duration of treatment, immediate information of the cost of prescription, and

  19. automatic discontinuation of drug administration on the day set by the prescriber

  20. physician, with reassessment of indications during the next 24-72 hours by a member

  21. of the working group.

  22. These antimicrobials were carbapenems (imipenem,meropenem), tigecycline, linezolid, voriconazole, candins (caspofungin, anidulafungin,micafungin), and lipid-associated amphotericin B (liposomal, lipid complex).

  23. In the ICU setting, an expert intensivist in infectious diseases was responsible for implementation

  24. of the program. Actions included daily review of antibiotics regimens of all patients

  25. during the shift change (8:00 AM, 3:00 PM, 9:00 PM), obligation to include the number

  26. of days of antimicrobial administration in the computerized clinical course record, and

  27. reasonable proposals of dose adjustment, de-escalation, or withdrawal in the daily

  28. clinical sessions of the ICU staff (2:00-3:30 PM).

  29. The AMS program was well accepted in the ICU setting, with no rejections by

  30. the ICU personnel. Details of the implementation of the recommendations were

  31. discussed at daily sessions and final decisions were taken by consensus of the ICU

  32. team. In case of disagreement, the expert’s opinion prevailed who had received

  33. empowerment by the medical director of the hospital and the chief of the ICU.

f:id:akinohanayuki:20180122051041p:plain

f:id:akinohanayuki:20180122051054p:plain

 

感想

シンプルな発表。ちなみに、ICUUCIアブストに記載しています。 

図はイケてません。バックグランドにAPACHE2スコアがあるのは、素晴らしいですので、メインアウトカムを死亡率にしてはと思いました。

 

 

Hospitalist(ホスピタリスト) Vol.5 No.3 2017(特集:感染症2)

Hospitalist(ホスピタリスト) Vol.5 No.3 2017(特集:感染症2)

  • 作者: 岡本耕,八重樫牧人
  • 出版社/メーカー: メディカルサイエンスインターナショナル
  • 発売日: 2017/10/02
  • メディア: 雑誌
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