Impact of antimicrobial stewardship managed by clinical pharmacists on antibiotic use and drug resistance in a Chinese hospital, 2010–2016: A retrospective observational study

BMJ OpenWang H, Wang H, Yu X, et al. | August 06, 2019

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Through a retrospective observational study of trends in antibiotic use and antimicrobial resistance (AMR) in the context of antimicrobial stewardship (AMS), researchers assessed the influence of AMS managed by clinical pharmacists on antibiotic utilization, prophylaxis, and AMR. Antibiotic prescriptions from 820 doctors involved all outpatients (n = 17,766,637) and inpatients (n = 376,627) from 2010 to 2016. Bacterial resistance data were from all inpatients (n = 350,699) from 2011 to 2016. The proportion of antibiotic prescriptions decreased in outpatients and in inpatients and the intensity of consumption declined from 102.46 to 37.38 DDD/100 bed-days. The proportion of antibiotic prophylaxis decreased from 98.94% to 18.93%. The proportion of rational timing of the initial dose progressed from 71.11% to 96.74%, and the proportion of rational duration increased from 2.84% to 42.63%. Time series analysis showed that the the resistance rates of Escherichia coli and Pseudomonas aeruginosa to fluoroquinolones decreased, and the incidence rate of methicillin-resistant Staphylococcus aureus also declined. On the other hand, the resistance rates of E. coli and Klebsiella pneumoniae to carbapenems rose. Antibiotic use was partially positively associated with AMR. Overall, in decreasing antibiotic use and surgical antibiotic prophylaxis, AMS had a significant role. AMR was positively associated with antibiotic use to some degree.

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