title: Prescribing trends before and after implementation of an antimicrobial stewardship program.
abstract: OBJECTIVE
  Antimicrobial stewardship programs are recommended to reduce antimicrobial resistance by reducing inappropriate use of antimicrobials. We implemented an antimicrobial stewardship program and aimed to evaluate its effect on broad-spectrum antimicrobial use.
  
  
  METHODS
  Observational study with historical control using interrupted time series analysis conducted in a tertiary referral hospital. Hospital inpatients prescribed restricted antimicrobials for non-standard indications, where approval had expired or without approval.
  
  
  METHODS
  Baseline period of 30 months immediately followed by an 18-03 intervention period commencing January 2011.
  
  
  METHODS
  Number and type of interventions made by antimicrobial stewardship team; monthly rate of use of broad-spectrum antimicrobial agents (in defined daily doses/1000 occupied bed-18s).
  
  
  RESULTS
  The antimicrobial stewardship team made 1104 recommendations in 779 patients during the 18-03 intervention period. In 64% of cases, the recommendation was made to cease or de-escalate the antimicrobial therapy, or to change from intravenous to oral therapy. The introduction of the intervention resulted in an immediate 17% (95% CI, 13%-20%) reduction in broad-spectrum antimicrobial use in the intensive care unit and a 10% (95% CI, 4%-16%) reduction in broad-spectrum antimicrobial use outside the intensive care unit. Reductions were particularly seen in cephalosporin and glycopeptide use, although these were partially offset by increases in the use of β-lactam-β-lactamase inhibitors.
  
  
  CONCLUSIONS
  The introduction of an antimicrobial stewardship program, including postprescription review, resulted in an immediate reduction in broad-spectrum antimicrobial use in a tertiary referral centre. However, the effect of this intervention reduced over time.
authors.affiliation: Alfred Health, Melbourne, VIC, Australia.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Cairns
authors.forename: Adam W J
authors.initials: AW
authors.lastname: Jenney
authors.forename: Iain J
authors.initials: IJ
authors.lastname: Abbott
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Skinner
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Doyle
authors.forename: Michael
authors.initials: M
authors.lastname: Dooley
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001315:Australia; D016022:Case-Control Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000639:trends*; D017723:Drug Utilization Review / Q000458:organization & administration*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement
chemical_list: D000890:Anti-Infective Agents