Research noteEffect of discontinuation of an antimicrobial stewardship programme on the antibiotic usage pattern
Introduction
Despite the trend of emphasis on the importance of antimicrobial stewardship programmes (ASPs), some hospitals in Korea have discontinued ASP due to a lack of workforce. The number of active infectious disease (ID) specialists, which is the main human resource for ASP in Korea, is limited [1,2].
Several studies have proved the efficacy of the introduction of ASP [3,4]. However, information about the consequences of ASP discontinuation is limited. This study aimed to analyse the effect of discontinuation of ASP activity on the antibiotic usage pattern.
Section snippets
Study setting
We conducted this retrospective study from September 2015 to August 2019 in an 859-bed university-affiliated secondary care hospital in Korea; the hospital has a 34-bed intensive care unit (ICU), a 20-bed trauma unit, a 30-bed neonatal ICU, and no burns or bone-marrow transplant units. There was no significant change in the overall staffing number of physicians and nurses and antibiotic formulary in the hospital during the study period. The number of hospitalized patients remained constant
Results
Table 1 shows the overall results. The use of restrictive antibiotics, increased immediately after the discontinuation of the ASP in the general ward and ICU. In addition, there were positive changes in the slope for the use of restrictive antibiotics in the general ward and ICU. The discontinuation of the ASP significantly decreased the level of broad-spectrum antibiotics in patients in the general ward. For non-broad-spectrum antibiotics, there were positive changes in the slope in the
Discussion
Although ‘prospective audit and feedback’ is the preferred strategy for ASP, most Korean hospitals have adopted a ‘restrictive antibiotic programme’ as the major strategy due to the lack of personnel for ASP [[9], [10], [11]]. An increase in the use of antibiotics not included as designated antibiotics (the balloon effect) is observed as a drawback of this measure. However, some studies have found that it significantly decreased the use of antibiotics not included as designated antibiotics as
Conclusions
After the discontinuation of the ASP, antibiotic usage patterns rapidly returned to the patterns prior to the implementation of the programme.
Author contributions
WJ contributed to drafting the manuscript and data curation. HH was involved in data curation, formal analysis, and visualization. H-uJ participated in the study design and collected the data. Y-HC participated in data collection. BK was involved in study conception and design, interpretation of results, and drafting the manuscript. All authors approved the final draft of the manuscript.
Transparency declaration
The authors declare that they have no conflicts of interest and no financial interests relevant to this study. This work was supported by a grant from the Bio & Medical Technology Development Program of the National Research Foundation (NRF), and funded by the Ministry of Science and ICT (MSIT) of the Korean government (Funding No. 2019M3E5D1A01066063). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Acknowledgements
The authors thank all medical staff at Eulji University Hospital for their cooperation in the antimicrobial stewardship programme.
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Wooyoung Jang and Hyeonjun Hwang contributed equally.