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Antimicrobial stewardship program reduces antibiotic use
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An antimicrobial stewardship program guided by infectious disease specialists significantly reduced antibiotic use in a Swedish university hospital without negatively affecting patient outcomes, according to recently published data.
“Most [antimicrobial stewardship programs] have been introduced in settings with high proportions of multi-resistant bacteria or as a counter-measure during outbreaks of resistant bacteria or Clostridium difficile infections,” the researchers wrote in Open Forum Infectious Diseases. “Few programs have been tested in Scandinavian hospitals where, historically the proportion of antimicrobial resistance has been low.”
The historically controlled study was conducted at Skåne University Hospital in Malmö, Sweden, where an antimicrobial stewardship program was established over 5 months during 2013. In twice-weekly checks, infectious disease specialists audited all hospitalized patients who were assigned or going to be treated with antibiotics. They compared the information gathered with a historical control of patients treated with antibiotics in the same wards in 2012. There were 781 cases included in the stewardship program, and 886 cases were included in the control group.
With the stewardship program, antibiotic use decreased 27% vs. the control period. This reduction was seen primarily in the use of broad-spectrum antibiotics, the researchers wrote.
Overall, fewer patients were started on antibiotics, and antibiotic courses were shorter (P < .001). The researchers observed an earlier switch to oral therapy as well as a reduction in the use of third-generation cephalosporins and fluoroquinolones.
No negative effects on patients with regard to mortality, readmission or length of stay were observed during the study period. Furthermore, the researchers wrote that hospital readmissions due to unresolved infection decreased following initiation of the stewardship program.
“We firmly believe that a focus on reducing antibiotics or cutting costs is not enough when conducting antimicrobial stewardship,” the investigators wrote. “A well-designed stewardship should focus on optimizing the treatment of the individual patient, while simultaneously minimizing collateral damage of antibiotic use to the individual and society. We also believe that this can be best attained by an individual assessment of each patient by an infectious disease specialist.”
Disclosure: The researchers report research funding from STRAMA Skåne.
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