title: A permission system for carbapenem use reduced incidence of drug-resistant bacteria and cost of antimicrobials at a general hospital in Japan.
abstract: Some drug management systems have been established in Japanese hospitals to reduce medical costs and regulate drug usage. Among the many available prescription drugs, antimicrobials should be given special attention because their inappropriate use often leads to sudden outbreaks of resistant bacteria. As drug specialists, pharmacists should monitor the use of all drugs, particularly antimicrobials. Carbapenems are a class of broad-spectrum antimicrobials that are widely used to treat infections worldwide. However, their inappropriate use has led to an increase in the incidence of drug-resistant bacteria and consequently, medical costs, at hospitals. To reduce inappropriate use and drug resistance, we have established a permission system to control the use of carbapenems at the Japanese Red Cross Nagoya Daiichi Hospital. In this study, we retrospectively evaluated the applicability of the new permission system compared to that of the notification system and the non control system for 14 months each. The two management systems were able to maintain total antibiotic use density and control the outbreak of drug-resistant bacteria (P. aeruginosa, E. coli, and K. pneumoniae). The number of carbapenem prescriptions was decreased dramatically when this permission system was enforced. Compared to the non control system, the cost of antimicrobials was reduced by $757,470 for the 14-month study period using the permission system. These results suggest that our system to control the use of antimicrobials can efficiently suppress the incidence of drug-resistant bacteria and medical costs at hospitals.
authors.affiliation: Department of Pharmacy, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Mamiya
authors.forename: Hideki
authors.initials: H
authors.lastname: Nishiyama
authors.forename: Shiho
authors.initials: S
authors.lastname: Narusawa
authors.forename: Takenao
authors.initials: T
authors.lastname: Koseki
authors.forename: Akihiro
authors.initials: A
authors.lastname: Mouri
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Nabeshima
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D015780:Carbapenems / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000191:economics; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D005240:Feasibility Studies; D017721:Hospital Costs / Q000458:organization & administration; D006769:Hospitals, General / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics / Q000517:prevention & control; D017053:Infection Control / Q000191:economics* / Q000379:methods; D007564:Japan; D007710:Klebsiella Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D050316:Medical Order Entry Systems / Q000191:economics; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000191:economics; D015397:Program Evaluation; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems