Outcomes of antimicrobial stewardship intervention in Japanese university hospital

Background: Antibiotic resistance within hospitals is becoming increasingly the major problem worldwide. Therefore, appropriate use of antimicrobials should be promoted, although prospective audit system based on the established antimicrobial stewardship has not always been prevalent widely in Japan.

Objective: We established prospective audit with intervention and feedback system in Gifu university hospital, and outcomes of our intervention were evaluated.

Methods: A physician and a clinical pharmacist in ICT have performed daily review of individual use of antimicrobial injection from a viewpoint of appropriateness according to the published guidelines since August 2009. The antimicrobial use density, duration of administration, and length of hospital stay in a year were compared before (n=6251) and after (n=6348) intervention. The appropriateness of antimicrobial use was also evaluated.

Results: Inappropriate use of antibiotics in dosage, choice and duration of administration were 6.6%, 4.0%, and 1.8%, respectively, before intervention. After intervention, all rates were significantly reduced to 0.5% for dosage, 0.22% for choice, 0.22% for duration (p<0.01). Moreover, the percentage of the use of antibiotics over a week was significantly reduced from 25% to 23% (p=0.049). The length of hospital stay was ultimately reduced from 12 days(7-23)(IQR) to 11 days (6-21)(p<0.001).

Conclusions: Our present intervention to promote proper use of antibiotics based on a strategy of prospective audit with intervention and feedback was found to be effective in reducing inappropriate use of antimicrobial and in shortening the length of hospital stay.