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31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea

BACKGROUND: The U.S. Centers for Disease Control and Prevention released the core elements of antimicrobial stewardship program (ASP). In some countries, however, they may be difficult to apply in countries with limited resources. In this study, we evaluated the impact of successful ASP implementati...

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Autores principales: Shin, Dong Hoon, kim, Hyung-sook, Heo, Eunjeong, Shin, Myoung Jin, Kim, Nak-Hyun, Lee, Hyunju, Park, Jeong Su, Park, Kyoung Un, Jung, Jongtak, Song, Kyoung-Ho, Kang, Minsun, Jung, Jaehun, Kim, Eu Suk, Kim, Hong Bin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644310/
http://dx.doi.org/10.1093/ofid/ofab466.233
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author Shin, Dong Hoon
kim, Hyung-sook
Heo, Eunjeong
Shin, Myoung Jin
Kim, Nak-Hyun
Lee, Hyunju
Park, Jeong Su
Park, Kyoung Un
Jung, Jongtak
Song, Kyoung-Ho
Kang, Minsun
Jung, Jaehun
Kim, Eu Suk
Kim, Hong Bin
author_facet Shin, Dong Hoon
kim, Hyung-sook
Heo, Eunjeong
Shin, Myoung Jin
Kim, Nak-Hyun
Lee, Hyunju
Park, Jeong Su
Park, Kyoung Un
Jung, Jongtak
Song, Kyoung-Ho
Kang, Minsun
Jung, Jaehun
Kim, Eu Suk
Kim, Hong Bin
author_sort Shin, Dong Hoon
collection PubMed
description BACKGROUND: The U.S. Centers for Disease Control and Prevention released the core elements of antimicrobial stewardship program (ASP). In some countries, however, they may be difficult to apply in countries with limited resources. In this study, we evaluated the impact of successful ASP implementation on antibiotic use and resistance rates in an institution with limited infrastructural support. METHODS: A series of ASP activities were reviewed according to the core elements of ASP. The retrospective data of all hospitalized patients at a tertiary care teaching hospital was collected from January 2010 to December 2019, including antibiotic prescription data and culture results of all clinical specimens. The trends of the antibiotic-resistant rates were compared with nationwide data in Korea. The trend analyses were performed with 2-sided correlated seasonal Mann-Kendall nonparametric tests. RESULTS: The ASP activities over the past decade were summarized in Table. After activities such as preauthorization were achieved, other ASP activities were added one by one. Also, the infectious disease pharmacists, as ASP co-leaders, mainly carried out the following activities: reducing redundant anti-anaerobic antimicrobials and intravenous fluoroquinolones, and advised the physicians to discontinue the antibiotic prescription in cases when the intervention was plausible. After the ASP implementation, total antibacterial use significantly decreased (P < 0.01; Figure). The use of glycopeptides (P < 0.01) and fluoroquinolones (P < 0.01) gradually decreased, while the use of third-generation cephalosporines did not significantly change (P=0.48). There was no significant change in total carbapenems use, but ertapenem use increased (P=0.02). Compared with the nationwide data, methicillin-resistant Staphylococcus aureus was on a decreasing trend consistently. Although third-generation cephalosporin-resistant Escherichia coli increased, third-generation cephalosporin resistant-Klebsiella pneumoniae and carbapenem resistant-Pseudomonas aeruginosa did not increase. Table. Antimicrobial stewardship activities for hospitalized patients over the past decade in Seoul National University Bundang Hospital. ASP: antimicrobial stewardship; ID: infectious disease; CDSS: Clinical decision support system [Image: see text] Figure. DOT per 1,000 patient-days in Seoul National University Bundang Hospital and implemented actions of antimicrobial stewardship program. DOT: days of therapy; ID: infectious disease; PCR: polymerase chain reaction; GPC: gram positive cocci; Group 1 carbapenem: ertapenem [Image: see text] CONCLUSION: A stepwise implementation of the core ASP elements was effective in improving the appropriate use of antibiotics and reducing the antibiotic resistant organisms, even with limited human resources. DISCLOSURES: All Authors: No reported disclosures
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spelling pubmed-86443102021-12-06 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea Shin, Dong Hoon kim, Hyung-sook Heo, Eunjeong Shin, Myoung Jin Kim, Nak-Hyun Lee, Hyunju Park, Jeong Su Park, Kyoung Un Jung, Jongtak Song, Kyoung-Ho Kang, Minsun Jung, Jaehun Kim, Eu Suk Kim, Hong Bin Open Forum Infect Dis Poster Abstracts BACKGROUND: The U.S. Centers for Disease Control and Prevention released the core elements of antimicrobial stewardship program (ASP). In some countries, however, they may be difficult to apply in countries with limited resources. In this study, we evaluated the impact of successful ASP implementation on antibiotic use and resistance rates in an institution with limited infrastructural support. METHODS: A series of ASP activities were reviewed according to the core elements of ASP. The retrospective data of all hospitalized patients at a tertiary care teaching hospital was collected from January 2010 to December 2019, including antibiotic prescription data and culture results of all clinical specimens. The trends of the antibiotic-resistant rates were compared with nationwide data in Korea. The trend analyses were performed with 2-sided correlated seasonal Mann-Kendall nonparametric tests. RESULTS: The ASP activities over the past decade were summarized in Table. After activities such as preauthorization were achieved, other ASP activities were added one by one. Also, the infectious disease pharmacists, as ASP co-leaders, mainly carried out the following activities: reducing redundant anti-anaerobic antimicrobials and intravenous fluoroquinolones, and advised the physicians to discontinue the antibiotic prescription in cases when the intervention was plausible. After the ASP implementation, total antibacterial use significantly decreased (P < 0.01; Figure). The use of glycopeptides (P < 0.01) and fluoroquinolones (P < 0.01) gradually decreased, while the use of third-generation cephalosporines did not significantly change (P=0.48). There was no significant change in total carbapenems use, but ertapenem use increased (P=0.02). Compared with the nationwide data, methicillin-resistant Staphylococcus aureus was on a decreasing trend consistently. Although third-generation cephalosporin-resistant Escherichia coli increased, third-generation cephalosporin resistant-Klebsiella pneumoniae and carbapenem resistant-Pseudomonas aeruginosa did not increase. Table. Antimicrobial stewardship activities for hospitalized patients over the past decade in Seoul National University Bundang Hospital. ASP: antimicrobial stewardship; ID: infectious disease; CDSS: Clinical decision support system [Image: see text] Figure. DOT per 1,000 patient-days in Seoul National University Bundang Hospital and implemented actions of antimicrobial stewardship program. DOT: days of therapy; ID: infectious disease; PCR: polymerase chain reaction; GPC: gram positive cocci; Group 1 carbapenem: ertapenem [Image: see text] CONCLUSION: A stepwise implementation of the core ASP elements was effective in improving the appropriate use of antibiotics and reducing the antibiotic resistant organisms, even with limited human resources. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2021-12-04 /pmc/articles/PMC8644310/ http://dx.doi.org/10.1093/ofid/ofab466.233 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Poster Abstracts
Shin, Dong Hoon
kim, Hyung-sook
Heo, Eunjeong
Shin, Myoung Jin
Kim, Nak-Hyun
Lee, Hyunju
Park, Jeong Su
Park, Kyoung Un
Jung, Jongtak
Song, Kyoung-Ho
Kang, Minsun
Jung, Jaehun
Kim, Eu Suk
Kim, Hong Bin
31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea
title 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea
title_full 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea
title_fullStr 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea
title_full_unstemmed 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea
title_short 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea
title_sort 31. stepwise expansion of antimicrobial stewardship program and its impact on antibiotic use and resistance rates in a tertiary care hospital in korea
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8644310/
http://dx.doi.org/10.1093/ofid/ofab466.233
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