title: Long-term effects of an antimicrobial stewardship programme at a tertiary-care teaching hospital.
abstract: Antimicrobial stewardship has been shown to reduce unnecessary antibiotic use, but there are few data on the long-term benefits of such a programme. Antimicrobial use over a 13-year period since implementing an antimicrobial stewardship programme (ASP) at our institution was examined. Nosocomial rates of Clostridium difficile infection (CDI) and antimicrobial susceptibility patterns of common nosocomial micro-organisms over the same period were also reviewed. Total antimicrobial use decreased by 62.8% (P<0.0001). There were decreases in use of aminoglycosides (-91.3%; P<0.0001), cephalosporins (-68.3%; P<0.0001), extended-spectrum penicillins (-77.7%; P<0.0001), macrolides (-27.2%; P=0.002), clindamycin (-95.9%; P<0.0001) and quinolones (-78.7%; P<0.0001). Antifungal use decreased by 71.0% (P<0.0001). There were increases in the use of carbapenems (+736%, P<0.0001) and anti-MRSA drugs (+73.3%; P<0.0001). There was a 56.7% (P=0.007) reduction in nosocomial MRSA infections. Nosocomial CDI rates decreased by 42.6% (P=0.005) between 2003 and 2010 and then increased to near baseline levels following implementation of more sensitive testing for detection of CDI in 2011. There were decreases in the rate (-71.9%; P=0.001) and percentage (-51.4%; P<0.0001) of quinolone-resistant Pseudomonas aeruginosa. There were decreases in the rate (P<0.0001) and percentage (P=0.02) of carbapenem-resistant P. aeruginosa following implementation of a policy restricting ciprofloxacin use. We have demonstrated sustained reductions in both antimicrobial use and drug-resistant organisms following implementation of an ASP.
authors.affiliation: Brody School of Medicine at East Carolina University, Department of Medicine, Division of Infectious Diseases, Greenville, NC 27834, USA. Electronic address: cookp@ecu.edu.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Cook
authors.affiliation: Department of Pharmacy, Vidant Medical Center, Greenville, NC, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gooch
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification; D011307:Drug Prescriptions / Q000592:standards*; D024881:Drug Resistance, Bacterial; D004358:Drug Therapy / Q000379:methods / Q000592:standards; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D062606:Tertiary Care Centers; D013995:Time
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Antimicrobial stewardship; Clostridium difficile; Meticillin-resistant Staphylococcus aureus; Multidrug-resistant Pseudomonas aeruginosa