Effect of the Electronic Antibiotic Stewardship program in reducing DDDs of antibiotics in a second‐level hospital
Authors: Laisser Rogers Loishooki , Moreno Úrsula Fabiola Medina , Meléndez Javier Araujo , Álvarez Arturo Ortiz , Moscoso Antonio Gordillo , De León Díaz de León Edgar Alejandro 
Published: April 2020

Background

It is estimated that up to 50% of all antibiotic’s prescription is unnecessary or are not optimally effective. The World Health Organization (WHO) has proposed a broad of antimicrobial stewardship programs (AMS) implementation in hospitals to control and monitor antibiotics consumption in the aim to minimize resistance and improve patient’s clinical outcome. AMS strategies involve providing prospective audits/feedback, formulary restriction, local education, implementing evidence‐based guidelines, de‐escalation, dose optimization and intravenous to oral therapy switch.

Objective

To evaluate the effect of the implementation of an electronic version of the antibiotic stewardship program in minimizing antibiotics consumption of Defined Daily Dose (DDDs) in adults with infectious emergency diseases at a secondary‐level hospital.

Methodology

Time series ecological study, carried out at Hospital Central Dr. Ignacio Morones Prieto, a second‐level public hospital. The study had three phases: 1) pre‐implementation (2016–17), 2) initial phase, started 2017–18 and 3) post‐implementation on 2018–19 with all the stewardship components intergraded. The effect on consumption assessed with the WHO index of DDDs per 100 bed‐days comparing the three phases. The antibiotics enrolled and analyzed: ceftriaxone, cefepime, ceftazidime, cefotaxime, cephalothin, piperacillin/tazobactam, meropenem, ertapenem, imipenem, vancomycin, amikacin, ciprofloxacin, levofloxacin, clindamycin, linezolid which are used in Medicine, Surgery and Intensive Care Services.

Results

AMS implementation led to a year reduction in total antibiotic consumption of 18.6% (phase 1 vs phase 3), and 17.7% (phase 1 vs phase 2). Regarding the consumption analyzed by hospital services, the ICU managed to reduce 22% of antibiotic consumption during the initial phase (phase 1 vs phase 3), and 24% reduction (phase 1 vs phase 2) followed by Internal Medicine with 21.78% reduction (phase 1 vs phase 3) and 22.28% reduction (phase 1 vs phase 2).

Conclusion

The decrease observed is probably due to the implementation of the AMS program, it's strict monitoring with adequate human and pharmacological resources. Very few data are available of the AMS program on the Latin America region especially in Mexico, that why this study is substantial promoting the implementation of this program in the region.

Shows trends of five antibiotics per 100 bed‐days, in ICU, Medicine and Surgery in the three phases of the AMS program.

Antibiotics

Intensive Care Unit

Medicine

Surgery

2016–17

2017–18

2018–19

2016–17

2017–18

2018–19

2016–17

2017–18

2018–19

Imipenem

1002.8

644.5

81.0

589.2

293.3

224.8

436.3

411.9

315.4

Ciprofloxacin

4466.2

2068.3

2064.8

3440.2

1657.2

1170.4

2493.4

2288.3

1501.5

Ceftriaxone

1365.8

1768.6

1748.3

1361.2

1515.9

1785.2

1354.5

1255.9

1679.6

Cefotaxime

33.5

184.3

67.1

64.9

84.9

195.9

46.2

45.0

18.9

Linezolid

223.4

165.4

127.5

58.9

18.7

53.2

4.7

23.8

57.7