The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention

• Main Authors: Mahmoudi L (Author), Sepasian A (Author), Firouzabadi D (Author), Akbari A (Author)
• Format: Book
• Published: Dove Medical Press, 2020-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1179-1594
• Keywords: antimicrobial stewardship programs; appropriate prescribing; antimicrobial use; ddd; defined daily dose; Public aspects of medicine; RA1-1270
• Source: Risk Management and Healthcare Policy, Vol Volume 13, Pp 1701-1709 (2020)

Laleh Mahmoudi,1 Alireza Sepasian,1 Dena Firouzabadi,1,* Ali Akbari2,* 1Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 2Department of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran*These authors contributed equally to this workCorrespondence: Ali AkbariDepartment of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, IranTel/ Fax [phone]Email [e-mail] FirouzabadiDepartment of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IranTel [phone]Fax [phone]Email [e-mail]: Inappropriate use of antimicrobials (AM) is a major concern worldwide that leads to the propagation of antimicrobial resistance (AMR). In addition to its clinical implications, AMR imposes an economic burden on communities, especially developing countries with more infectious diseases and less available resources. Antimicrobial stewardship programs (ASPs) have been found to be effective in reducing AMR. This study was designed to evaluate the effect of implementing an ASP in reducing AM consumption, its economic burden, and AMR as a consecutive result.Materials and Methods: Consumption of caspofungin, amphotericin B, voriconazole, colistin, linezolid, vancomycin, and carbapenems was compared in a prospective cross-sectional study between two time periods introduced as pre- and post-ASP. Drug use density presented as anatomical therapeutic chemical (ATC)/defined daily doses (DDD) and normalized per 1000 bed days, cost savings, and AMR patterns were evaluated.Results: A total of 9400 AM prescriptions were analyzed during a 2-year period. Consumption measured in DDD/1000 bed days dropped by 24.8, 25.0, 35.3, 47.0, 39.2, 10.5, and 23.2 percent for amphotericin B, caspofungin, colistin, voriconazole, meropenem, imipenem, and vancomycin, respectively. Linezolid consumption increased by 26.8% after implementing ASP. The expenditure of target AMs in the average value of USD decreased by 41.3% after the intervention compared to the time before using ASP (P-value=0.001). Implementing ASP also increased AM susceptibility of Pseudomonas aeruginosa, while the susceptibility of methicillin-resistant Staphylococcus aureus did not change significantly.Conclusion: The results of this study suggest that establishment of ASP can lead to a reduction in improper administration of AMs and their expenditure resulting in economic benefit and lowering AMR at hospitals with minimum resources. Clinical pharmacists’ role was critical to the success of this ASP and was uniquely empowered at our center.Keywords: antimicrobial stewardship programs, appropriate prescribing, antimicrobial use, DDD, defined daily dose