Impact of computerized pre-authorization of broad spectrum antibiotics in Pseudomonas aeruginosa at a children's hospital in Japan.
BACKGROUND
The spread of antimicrobial-resistant organisms is a global concern. To stem this tide, an antimicrobial stewardship program at hospitals is essential to optimize the prescription of broad spectrum antibiotics. In this study we examined the impact of computerized pre-authorization for broad spectrum antibiotics for Pseudomonas aeruginosa at a children's hospital.


METHODS
An antimicrobial stewardship program at Tokyo Metropolitan Children's Medical Center was assessed between March 2010 and March 2015. A paper-based post-prescription audit was switched to computerized pre-authorization for broad antipseudomonal agents in October 2011. The prescriber was required to obtain approval from physicians in the pediatric infectious diseases division before prescribing restricted antimicrobial agents. Approved prescriptions were processed and logged electronically. We evaluated days of therapy per 1000 patient-days, the cost of antibiotics, and the susceptibility of P. aeruginosa to piperacillin, ceftazidime, cefepime, piperacillin/tazobactam, carbapenems, and ciprofloxacin. Also, the average length of admission and infection-related mortality at 30 days were compared pre- and post-intervention.


RESULTS
Administration of carbapenems, piperacillin/tazobactam, and ceftazidime decreased significantly after the introduction of computerized pre-authorization. Antibiotic costs were reduced by JPY2.86 million (USD 26,000) annually. None of the antipseudomonal agents showed decreased sensitivity. The average length of admission was shorter in post-intervention. Infection-related mortality at 30 days showed no difference between the pre- and post-intervention periods.


CONCLUSIONS
An antimicrobial stewardship program using computerized pre-authorization decreased the use and cost of broad spectrum antibiotics without significant difference in infection-related mortality at 30 days, although our study did not improve susceptibilities of P. aeruginosa.
Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Japan. Electronic address: yuho_horikoshi@tmhp.jp.
Yuho
Y
Horikoshi
Division of Microbiology, Department of Clinical Laboratory, Tokyo Metropolitan Children's Medical Center, Japan.
Hiroshi
H
Higuchi
Department of Pharmacy, Tokyo Metropolitan Children's Medical Center, Japan.
Junichi
J
Suwa
Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Japan.
Mihoko
M
Isogai
Division of Pediatric Infectious Diseases, Shizuoka Children's Hospital, Japan.
Takayo
T
Shoji
Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Japan.
Kenta
K
Ito
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D000077723:Cefepime; D002442:Ceftazidime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D006761:Hospitals; D006801:Humans; D007564:Japan; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D014041:Tokyo
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015780:Carbapenems; D002511:Cephalosporins; D000077725:Piperacillin, Tazobactam Drug Combination; D000077723:Cefepime; D010397:Penicillanic Acid; D002442:Ceftazidime; D010878:Piperacillin
Antimicrobial stewardship program; Carbapenems; Children's hospital; Pre-authorization; Pseudomonas aeruginosa; Resistant organism