Maastricht's experience in implementing an Antimicrobial Stewardship program
Kort, J.M.L. de, Benus, R.F.J., Moens, A.A., Thiel, F.H. van, Posthouwer, D.
Voorzitter(s): prof.dr. J.W. de Fijter, Leiden & dr. P.J. de Vries, Hilversum
Locatie(s): Zaal 0.5
Categorie(ën):
Introduction: Inappropriate antimicrobial use is strongly associated with emergence of antimicrobial resistance, thereby increasing difficulties in treating infections. To address this problem Antimicrobial stewardship (A-team), aiming at improved use of antibiotics, has been recommended by the Dutch Working Party on Antibiotic Policy for every hospital in the Netherlands. The A-team has a multifaceted approach: optimizing adequate and appropriate antibiotic use, review and feedback on prescriptions and epidemiologic surveillance of antibiotic resistance.
Aim of the study: To investigate the impact of the review and feedback method.
Materials and Methods: In our 715-bed university hospital, two surgical wards (41 respectively 32 beds) with high rate of antibiotic prescription were selected. Prescriptions of antibiotics were extracted and gathered from the electronic prescribing software system. Every prescribed course of antibiotic was defined as one antibiotic event. These events were scored for appropriateness and adequacy with respect to antibiotic use. Appropriateness was defined as prescription according to local guidelines. An antibiotic event was adequate if the antibiotic was appropriately prescribed and was deemed effective based on the identification of the microorganism and susceptibility pattern. Adequacy also involved minimizing unnecessary use of broad-spectrum antibiotics. The study was composed by two consecutive arms of 6 weeks. First, a single-blinded observation arm in which there was no intervention. Followed by, an intervention arm in which observed deviations for appropriate and adequate antibiotic use were reviewed and in which feedback on improved antibiotic use was given.
Results: During the observation period 122 antibiotic events were reviewed: 46% were classified as appropriate and 42% were adequate. Throughout the intervention period 164 antibiotic events were reviewed: in 80 events feedback was given. The review and feedback strategy resulted in a 56% appropriate use of antibiotics, a relative increase of approximately 22% when compared to the observation period. Moreover, adequacy use was improved to 63%, a relative increase of approximately 50%. The measured workload for these two wards was 10 hours per week.
Conclusion: The implementation of a review and feedback strategy by our A-team resulted in an improvement of appropriateness and adequacy of the antibiotic treatment of respectively 22% and 50% in comparison with antibiotic use during the observation period.