title: Non-Restrictive Antimicrobial Stewardship Program in a General and Emergency Surgery Unit.
abstract: BACKGROUND
  The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobial drug resistance and reduce adverse drug events, optimizing the selection, dosing, and duration of therapy in individual patients.
  
  
  METHODS
  This retrospective study evaluated changes in antimicrobial agent use associated with implementation of an ASP in a general and emergency unit. The pre-intervention and post-intervention periods were defined as July 1, 2013, to December 31, 2013 (pre-intervention) and January 1, 2014, to June 30, 2014 (post-intervention).
  
  
  RESULTS
  The mean total monthly antimicrobial use decreased by 18.8%, from 1,074.9 defined daily doses (DDD) per 1,000 patient-days to 873.0 DDD per 1,000 patient-days after the intervention. There was a significant reduction in the use of piperacillin-tazobactam, by 33.7% (p < 0.05), in imipenem/cilastatin, by 63.9% (p < 0.05), in meropenem by 68.0% (p < 0.05), and in levofloxacin by 45.0% (p < 0.05) without any negative effect on patient susceptibility to infections. Indeed, patient outcomes, including deaths, length of stay in the hospital, and re-admission within 30 days were not affected.
  
  
  CONCLUSIONS
  The implementation of an education-based ASP achieved a significant improvement in all antimicrobial agent prescriptions in the surgical unit and a reduction in antimicrobial drug consumption, even when no restrictive measures were implemented.
authors.affiliation: 1 Department of Surgery, Macerata Hospital , Macerata, Italy .
authors.forename: Massimo
authors.initials: M
authors.lastname: Sartelli
authors.affiliation: 2 Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health , UNIVPM, Ancona, Italy .
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Labricciosa
authors.affiliation: 3 Unit of Hospital Pharmacy, Macerata Hospital , Macerata, Italy .
authors.forename: Loredana
authors.initials: L
authors.lastname: Scoccia
authors.affiliation: 4 Unit of Laboratory Medicine, Macerata Hospital , Macerata, Italy .
authors.forename: Jessica
authors.initials: J
authors.lastname: Bellesi
authors.affiliation: 5 Clinical Administration, Macerata Hospital , Macerata, Italy .
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Mazzoccanti
authors.affiliation: 5 Clinical Administration, Macerata Hospital , Macerata, Italy .
authors.forename: Giorgia
authors.initials: G
authors.lastname: Scaloni
authors.affiliation: 5 Clinical Administration, Macerata Hospital , Macerata, Italy .
authors.forename: Bianca
authors.initials: B
authors.lastname: Gentilozzi
authors.affiliation: 6 Unit of Infectious Diseases, Macerata Hospital , Macerata, Italy .
authors.forename: Alessandro
authors.initials: A
authors.lastname: Chiodera
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D013502:General Surgery / Q000193:education / Q000592:standards; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards; D016730:Program Development; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
chemical_list: D000890:Anti-Infective Agents