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Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea

To optimize antibiotic use, the US CDC has outlined core elements of antimicrobial stewardship programs (ASP). However, they are difficult to implement in limited-resource settings. We report on the successful implementation of a series of ASP with insufficient number of infectious diseases speciali...

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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: American Society for Microbiology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241935/
https://www.ncbi.nlm.nih.gov/pubmed/35467411
http://dx.doi.org/10.1128/spectrum.00335-22
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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 To optimize antibiotic use, the US CDC has outlined core elements of antimicrobial stewardship programs (ASP). However, they are difficult to implement in limited-resource settings. We report on the successful implementation of a series of ASP with insufficient number of infectious diseases specialists. We retrospectively collected data regarding antibiotic administration and culture results of all patients admitted to a tertiary care teaching hospital, Seoul National University Bundang Hospital (SNUBH), from January 2010 to December 2019. Trends of antibiotic use and antibiotic resistance rates were compared with those from Korean national data. Trend analyses were performed using nonparametric, two-sided, correlated seasonal Mann–Kendall tests. Total antibiotic agent usage has significantly decreased with ASP implementation at SNUBH since 2010. National claim data from tertiary care hospitals have revealed an increase in the use of all broad-spectrum antibiotics except for third-generation cephalosporins (3GC). In contrast, at SNUBH, glycopeptide and fluoroquinolone use gradually decreased, and 3GC and carbapenem use did not significantly change. Furthermore, the rate of colonization with methicillin-resistant Staphylococcus aureus showed a consistently decreasing trend, while that with 3GC- and fluoroquinolone-resistant Escherichia coli significantly increased. Unlike the national rate, the rate of colonization with antibiotic resistant-Klebsiella pneumoniae did not increase and that of 3GC- and fluoroquinolone-resistant Pseudomonas aeruginosa significantly decreased. Stepwise implementation of core ASP elements was effective in reducing antibiotic use despite a lack of sufficient manpower. Long-term multidisciplinary teamwork is necessary for successful and sustainable ASP implementation. IMPORTANCE Antimicrobial stewardship programs aimed to optimize antibiotic use are difficult to implement in limited-resource settings. Our study indicates that stepwise implementation of core antimicrobial stewardship program elements was effective in reducing antibiotic use in a tertiary care hospital despite the lack of sufficient manpower.
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spelling pubmed-92419352022-06-30 Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at 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 Microbiol Spectr Research Article To optimize antibiotic use, the US CDC has outlined core elements of antimicrobial stewardship programs (ASP). However, they are difficult to implement in limited-resource settings. We report on the successful implementation of a series of ASP with insufficient number of infectious diseases specialists. We retrospectively collected data regarding antibiotic administration and culture results of all patients admitted to a tertiary care teaching hospital, Seoul National University Bundang Hospital (SNUBH), from January 2010 to December 2019. Trends of antibiotic use and antibiotic resistance rates were compared with those from Korean national data. Trend analyses were performed using nonparametric, two-sided, correlated seasonal Mann–Kendall tests. Total antibiotic agent usage has significantly decreased with ASP implementation at SNUBH since 2010. National claim data from tertiary care hospitals have revealed an increase in the use of all broad-spectrum antibiotics except for third-generation cephalosporins (3GC). In contrast, at SNUBH, glycopeptide and fluoroquinolone use gradually decreased, and 3GC and carbapenem use did not significantly change. Furthermore, the rate of colonization with methicillin-resistant Staphylococcus aureus showed a consistently decreasing trend, while that with 3GC- and fluoroquinolone-resistant Escherichia coli significantly increased. Unlike the national rate, the rate of colonization with antibiotic resistant-Klebsiella pneumoniae did not increase and that of 3GC- and fluoroquinolone-resistant Pseudomonas aeruginosa significantly decreased. Stepwise implementation of core ASP elements was effective in reducing antibiotic use despite a lack of sufficient manpower. Long-term multidisciplinary teamwork is necessary for successful and sustainable ASP implementation. IMPORTANCE Antimicrobial stewardship programs aimed to optimize antibiotic use are difficult to implement in limited-resource settings. Our study indicates that stepwise implementation of core antimicrobial stewardship program elements was effective in reducing antibiotic use in a tertiary care hospital despite the lack of sufficient manpower. American Society for Microbiology 2022-04-25 /pmc/articles/PMC9241935/ /pubmed/35467411 http://dx.doi.org/10.1128/spectrum.00335-22 Text en Copyright © 2022 Shin et al. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research Article
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
Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea
title Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea
title_full Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea
title_fullStr Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea
title_full_unstemmed Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea
title_short Stepwise Expansion of Antimicrobial Stewardship Programs and Its Impact on Antibiotic Use and Resistance Rates at a Tertiary Care Hospital in Korea
title_sort stepwise expansion of antimicrobial stewardship programs and its impact on antibiotic use and resistance rates at a tertiary care hospital in korea
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241935/
https://www.ncbi.nlm.nih.gov/pubmed/35467411
http://dx.doi.org/10.1128/spectrum.00335-22
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