Eight-Year Experience of Antimicrobial Stewardship Program and the Trend of Carbapenem Use at a Tertiary Acute-Care Hospital in Japan-The Impact of Postprescription Review and Feedback

Tsubasa Akazawa; Yoshiki Kusama; Haruhisa Fukuda; Kayoko Hayakawa; Satoshi Kutsuna; Yuki Moriyama; Hirotake Ohashi; Saeko Tamura; Kei Yamamoto; Ryohei Hara; Ayako Shigeno; Masayuki Ota; Masahiro Ishikane; Shunichiro Tokita; Hiroyuki Terakado; Norio Ohmagari

doi:10.1093/ofid/ofz389

Eight-Year Experience of Antimicrobial Stewardship Program and the Trend of Carbapenem Use at a Tertiary Acute-Care Hospital in Japan-The Impact of Postprescription Review and Feedback

Open Forum Infect Dis. 2019 Sep 5;6(10):ofz389. doi: 10.1093/ofid/ofz389. eCollection 2019 Oct.

Authors

Tsubasa Akazawa¹, Yoshiki Kusama^{2

3}, Haruhisa Fukuda⁴, Kayoko Hayakawa^{2

5}, Satoshi Kutsuna⁵, Yuki Moriyama⁵, Hirotake Ohashi¹, Saeko Tamura⁶, Kei Yamamoto⁵, Ryohei Hara¹, Ayako Shigeno¹, Masayuki Ota⁵, Masahiro Ishikane^{2

5}, Shunichiro Tokita¹, Hiroyuki Terakado¹, Norio Ohmagari^{2

3

5}

Affiliations

¹ Pharmaceutical Department, National Center for Global Health and Medicine, Tokyo, Japan.
² AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
³ Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan.
⁴ Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
⁵ Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
⁶ Department of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan.

Abstract

Objective: We implemented a stepwise antimicrobial stewardship program (ASP). This study evaluated the effect of each intervention and the overall economic impact on carbapenem (CAR) use.

Method: Carbapenem days of therapy (CAR-DOT) were calculated to assess the effect of each intervention, and antipseudomonal DOT were calculated to assess changes in use of broad-spectrum antibiotics. We carried out segmented regression analysis of studies with interrupted time series for 3 periods: Phase 1 (infectious disease [ID] consultation service only), Phase 2 (adding monitoring and e-mail feedback), and Phase 3 (adding postprescription review and feedback [PPRF] led by ID specialist doctors and pharmacists). We also estimated cost savings over the study period due to decreased CAR use.

Results: The median monthly CAR-DOT, per month per 100 patient-days, during Phase 1, Phase 2, and Phase 3 was 5.46, 3.69, and 2.78, respectively. The CAR-DOT decreased significantly immediately after the start of Phase 2, but a major decrease was not observed during this period. Although the immediate change was not apparent after Phase 3 started, CAR-DOT decreased significantly over this period. Furthermore, the monthly DOT of 3 alternative antipseudomonal agents also decreased significantly over the study period, but the incidence of antimicrobial resistance did not decrease. Cost savings over the study period, due to decreased CAR use, was estimated to be US $150 000.

Conclusions: Adding PPRF on the conventional ASP may accelerate antimicrobial stewardship. Our CAR stewardship program has had positive results, and implementation is ongoing.

Keywords: antimicrobial resistance; antimicrobial stewardship; carbapenem; stewardship program; cost savings; postprescription review and feedback.