JAC Advance Access published online on March 24, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh163
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Division of Infectious
Diseases, Department of Medicine, Brody School of Medicine at East
Carolina
University, Brody 3E-113, Greenville, NC 27858;
* Corresponding author. E-mail: cookp{at}mail.ecu.edu.
Received 6 November 2003
; revised 29 January 2004
; accepted 3 February 2004
Objective: To evaluate the effect
of an antimicrobial management programme on broad-spectrum antimicrobial
use and antimicrobial susceptibilities of common nosocomial pathogens
at a tertiary-care teaching hospital. Methods: Review of hospital charts of patients
who had been prescribed broad-spectrum antimicrobials 48 h
earlier. Recommendations to streamline or discontinue antimicrobials
were made based on results of available microbiology data, radiography
studies, as well as the working diagnosis at the time of review.
The charts were reviewed again on the following day to assess acceptance
or rejection of the recommendations. Antimicrobial use, measured
as defined daily dose per 1000 patient days (DDD/1000 PD), was determined before
and after the antimicrobial management programme was started and
was assessed as the mean quarterly use in the six quarters preceding
implementation of the programme compared to the most recent six
quarters that the programme has been in existence. Antibiotic susceptibilities
were obtained from the clinical microbiology laboratory. Results: Compared to the six quarters before
the programme, broad-spectrum antibiotic use decreased by 28% (693
DDD/1000 PD to 502 DDD/1000 PD, P = 0.003).
Total antifungal agent use decreased by a similar amount, i.e. 28% (144
DDD/1000 PD to 103 DDD/1000 PD, P = 0.02).
Total antimicrobial use decreased by 27% (1461 DDD/1000
PD to 1069 DDD/1000 PD, P = 0.0007). Susceptibilities
of common nosocomial Gram-negative organisms to commonly prescribed
antibiotics did not change significantly over the 3 years of the programme.
The rate of methicillin-resistant Staphylococcus aureus increased
significantly in the non-intensive care areas of the hospital (P = 0.02) and decreased significantly
in the intensive care areas of the hospital (P = 0.009)
over the 4 year period from 2000 to 2003. Conclusion: Implementation of an antibiotic
management programme resulted in substantial reductions in both
broad-spectrum and total antimicrobial consumption without having
a significant impact on antibiotic susceptibilities of common Gram-negative
microorganisms within the institution. The changes in MRSA rate
in the non-ICU and ICU settings may reflect infection control measures
that were in place during the study period.
Keywords: antimicrobial utilization, resistance, cost
containment, prescribing interventions
Reduction in broad-spectrum antimicrobial use associated
with no improvement in hospital antibiogram
2 Department of Pathology, Brody
School of Medicine
at East Carolina University, Greenville, NC 27858;
3 Division of Infectious
Diseases, Department of Medicine, Brody School of Medicine at East
Carolina
University, Brody 3E-113, Greenville, NC 27858; Department of Pathology, Brody
School of Medicine
at East Carolina University, Greenville, NC 27858;
4 University Health Systems of Eastern
Carolina,
Greenville, NC;
5 Departments
of Pharmacy and Medicine, Virginia Commonwealth University,
Medical College of Virginia Campus, Richmond, VA, USA
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