Postdoctoral Associate Boston University Chobanian & Avedisian School of Medicine Brookline, MA, United States
Abstract:
Background: Antimicrobial stewardship (AS) is crucial for reducing antimicrobial resistance. However, the factors of inappropriate antimicrobial use are complex, and effective interventions have to be found in each hospital.Hypothesis/
Objectives: We hypothesized that a key issue was a lack of awareness and understanding of the current circumstances of antimicrobial resistance. Our objective was to evaluate whether in-hospital AS, designed to elucidate current resistance trends and inform appropriate countermeasures, could effectively reduce antimicrobial resistance.Animals: We conducted a comprehensive analysis on 1,635 strains subjected to antimicrobial sensitivity testing, along with 28,843 antibiotic prescriptions. This assessment included evaluating the existing antimicrobial resistance patterns from the sensitivity tests and analyzing the changes in antibiotic use in our AS based on prescriptions by year.
Methods: Our approach involved creating an in-hospital antibiogram to track resistance spread, using Gram stains to estimate bacterial species, and recommending effective antibiotics. We specifically addressed the suspected inappropriate use of antibiotics, such as carbapenems and fluoroquinolones, suggesting alternatives. Furthermore, lectures on proper antibiotic use in clinical settings were delivered to interns from 2019.
Results: The interventions led to a 50% reduction in antibiotic prescriptions, with carbapenems usage dropping by 89% and reductions of injectable and oral enrofloxacin by 80% and 79%, respectively. Remarkably, the antibiogram showed a significant presence of ESBL-producing E. coli, which decreased from 53% to 22% incidence.Conclusions and Clinical Importance: Our findings underscore that AS programs, emphasizing in-hospital education on appropriate antibiotic use and antibiotic selection based on antibiogram data, can significantly curb antimicrobial resistance.
