The effect of the preauthorization system on oral antimicrobials at a maternal and children’s hospital in Japan

BACKGROUND: Antimicrobial stewardship programs (ASP) for oral antibiotics is limited, despite the fact that oral antibiotics account for 90% of total antibiotic consumption in developed countries. We aimed to analyze the effectiveness of ASP for oral antibiotics in a pediatric population. METHODS: We conducted a prospective study at a tertiary maternal and children fs hospital in Japan, consisting of 490 beds, with approximately 13,000 hospitalizations and 240,000 outpatient visits annually. Outpatient data on oral antimicrobial prescription, costs and proportions of resistant bacteria between 2013 and 2016 were analyzed. We conducted preauthorization and feedback as a means of intervention from October 2015 for targeted antimicrobials; vancomycin, linezolid, quinolones, faropenem, tebipenem pivoxil, polymyxin B. Antibiotic use density (AUD) was measured using days of therapy (DOT) /1000 visits. Interrupted time-series (ITS) analysis was performed to evaluate the effects of intervention. RESULTS: The main indications for use of targeted antimicrobials were urinary tract infections, pneumonia, and prophylactic administration in malignancy and were inappropriate in the majority prior to intervention. AUD and cost of targeted oral antimicrobials decreased from 11.0 DOT /1000 visits and 7,176 US dollars(USD) to 2.1 DOT/1000 visits and 1,665 USD, respectively (P < .001). ITS analysis showed that prescriptions for targeted antimicrobials decreased rapidly after initiation of preauthorization(-7.1 DOT /1000 visits; P < .001) (Figure 2-a). Prescriptions for non-targeted oral antimicrobial increased temporarily (+28 DOT/1000 visits; P < .001), but a decreasing trend was found after the initiation (P < .001) (Figure 2-b). During this study period, the susceptibility against quinolones did not change for E.coli, K.pneumoniae, and P.aeruginosa. CONCLUSION: Introduction of the preauthorization system for selected oral antimicrobials decreased the AUD of both targeted and non-targeted antimicrobials. DISCLOSURES: N. Kinoshita, Standardization and dissemination of a community based network of infection control targeting children MHLW H29-SHINKOGYOSEI-IPPAN-002: Board Member, Salary; I. Miyairi, Standardization and dissemination of a community based network of infection control targeting children MHLW H29-SHINKOGYOSEI-IPPAN-002: Grant Investigator, Research grant