title: Antimicrobial stewardship of Chinese ministry of health reduces multidrug-resistant organism isolates in critically ill patients: a pre-post study from a single center.
abstract: China's Ministry of Health (MOH) has established a policy about the antimicrobial stewardship. To date, the effects of this policy on multidrug-resistant organism (MDRO) in critically ill patients are unknown.
  
  
  
  A pre-post study was conducted on intensive care unit (ICU) patients from June 2010 to May 2011 and from June 2012 to May 2013. Bacterial cultures were conducted at ICU admission and discharge. In June 2011, our hospital started to administer the antimicrobial stewardship program of Chinese MOH. We collected the data on antimicrobial consumption during the 3-year period in all hospital and individual department every month, and analyzed the correlation between the proportion of critically patients colonized or infected with MDRO and antimicrobial consumption.
  
  
  
  A total of 978 patients were involved in the present study. With the intervention, the monthly mean Defined Daily Dose (DDD) per 100 occupied bed-days throughout the hospital decreased from 96 ± 7 to 65 ± 6 (p < 0.001), and the proportion of patients colonized or infected with MDRO decreased from 36 to 13% at the time of ICU admission and declined from 48 to 29% at the time of ICU discharge (both p < 0.001). There was a significant positive relationship between the proportion of all critically ill patients colonized or infected with MDRO at ICU admission and the DDD of the entire hospital (R2= 0.7858, p < 0.001).
  
  
  
  The antimicrobial stewardship program of Chinese MOH reduced the consumption of antibiotics. Moreover, the proportion of patients colonized or infected with MDRO decreased along with reduced consumption of antibiotics.
  
  
  
  Retrospectively registered: NCT02128399; Date of registration: 22 APR 2014; Detail information web link: https://clinicaltrials.gov/ct2/show/NCT02128399?term=NCT02128399&rank=1.
authors.affiliation: School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430074, China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xie
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
authors.forename: Fengmei
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Gao
authors.affiliation: Department of Pharmacy, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Shao
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
authors.forename: Yingzi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China.
authors.forename: Congshan
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China. haiboq2000@163.com.
authors.forename: Haibo
authors.initials: H
authors.lastname: Qiu
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D002681:China; D003422:Critical Care; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data* / Q000639:trends; D006291:Health Policy; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial consumption; Antimicrobial stewardship; Defined daily dose; Multidrug-resistant organism