title: Implementing an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a 200-bed community hospital in Germany.
abstract: BACKGROUND
  Prescription of third-generation cephalosporins and fluoroquinolones has been linked to an increasing incidence of gram-negative bacteria producing extended-spectrum beta-lactamases, methicillin-resistant Staphylococcus aureus and nosocomial infection with Clostridium difficile. Antibiotic stewardship (ABS) programmes offer evidence-based tools to control antibiotic prescription rates and thereby influence the incidence of nosocomial infection and contain the development of multidrug-resistant bacteria, but there is limited experience with such programmes at community hospitals.
  
  
  METHODS
  We implemented an ABS programme at a 200-bed community hospital and aimed at a > 30 % reduction of cephalosporin and fluoroquinolone consumption within 1 year. Pharmacy data were obtained to estimate hospital-wide drug use density expressed in WHO-ATC-defined daily doses (DDD) or hospital-adapted recommended daily doses (RDD) per 1,000 patient days. The effect of the ABS intervention on drug use density was analysed using interrupted time-series analysis for the periods between January 2011 and March 2013 as pre-intervention, and between April 2013 and March 2014 as post-intervention period. The CDI incidence was calculated based on microbiology laboratory data.
  
  
  RESULTS
  Cephalosporin use (measured in RDD/1,000 patient days) decreased by 33 %, and fluoroquinolone use decreased by 31 %, respectively. Interrupted time-series analysis confirmed significant changes in the drug use density trends for both cephalosporins and fluoroquinolones after the intervention as well as for total antibiotic use that decreased by 11 % while no significant effect was noted for CDI incidence rates.
  
  
  CONCLUSIONS
  ABS programmes can be effective in community hospitals and may help establish ecologically advantageous antibiotic strategies when needed.
authors.affiliation: Ortenauklinikum Achern, Medizinische Klinik, Sektion Infektiologie, Josef-Wurzler-Straße 7, 77855, Achern, Germany, johannes.borde@web.de.
authors.forename: J P
authors.initials: JP
authors.lastname: Borde
authors.forename: S
authors.initials: S
authors.lastname: Litterst
authors.forename: M
authors.initials: M
authors.lastname: Ruhnke
authors.forename: R
authors.initials: R
authors.lastname: Feik
authors.forename: J
authors.initials: J
authors.lastname: Hübner
authors.forename: K
authors.initials: K
authors.lastname: deWith
authors.forename: K
authors.initials: K
authors.lastname: Kaier
authors.forename: W V
authors.initials: WV
authors.lastname: Kern
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D024841:Fluoroquinolones / Q000008:administration & dosage / Q000627:therapeutic use; D005858:Germany / Q000453:epidemiology; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D065186:Interrupted Time Series Analysis; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D055656:Prescriptions / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones