title: Outcome measurement of extensive implementation of antimicrobial stewardship in patients receiving intravenous antibiotics in a Japanese university hospital.
abstract: BACKGROUND
  Antimicrobial stewardship has not always prevailed in a wide variety of medical institutions in Japan.
  
  
  METHODS
  The infection control team was involved in the review of individual use of antibiotics in all inpatients (6348 and 6507 patients/year during the first and second annual interventions, respectively) receiving intravenous antibiotics, according to the published guidelines, consultation with physicians before prescription of antimicrobial agents and organisation of education programme on infection control for all medical staff. The outcomes of extensive implementation of antimicrobial stewardship were evaluated from the standpoint of antimicrobial use density, treatment duration, duration of hospital stay, occurrence of antimicrobial-resistant bacteria and medical expenses.
  
  
  RESULTS
  Prolonged use of antibiotics over 2 weeks was significantly reduced after active implementation of antimicrobial stewardship (2.9% vs. 5.2%, p < 0.001). Significant reduction in the antimicrobial consumption was observed in the second-generation cephalosporins (p = 0.03), carbapenems (p = 0.003), aminoglycosides (p < 0.001), leading to a reduction in the cost of antibiotics by 11.7%. The appearance of methicillin-resistant Staphylococcus aureus and the proportion of Serratia marcescens to Gram-negative bacteria decreased significantly from 47.6% to 39.5% (p = 0.026) and from 3.7% to 2.0% (p = 0.026), respectively. Moreover, the mean hospital stay was shortened by 2.9 days after active implementation of antimicrobial stewardship.
  
  
  CONCLUSIONS
  Extensive implementation of antimicrobial stewardship led to a decrease in the inappropriate use of antibiotics, saving in medical expenses, reduction in the development of antimicrobial resistance and shortening of hospital stay.
authors: Department of Pharmacy, Gifu University Hospital, Gifu, Japan.
authors: T
authors: T
authors: Niwa
authors: Y
authors: Y
authors: Shinoda
authors: A
authors: A
authors: Suzuki
authors: T
authors: T
authors: Ohmori
authors: M
authors: M
authors: Yasuda
authors: H
authors: H
authors: Ohta
authors: A
authors: A
authors: Fukao
authors: K
authors: K
authors: Kitaichi
authors: K
authors: K
authors: Matsuura
authors: T
authors: T
authors: Sugiyama
authors: N
authors: N
authors: Murakami
authors: Y
authors: Y
authors: Itoh
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D000890:Anti-Infective Agents / Q000191:economics / Q000627:therapeutic use*; D017046:Cost Savings; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D005260:Female; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D007262:Infusions, Intravenous; D007564:Japan; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011364:Professional Practice; D019564:Unnecessary Procedures
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents