Implementation and outcomes of hospital-wide computerized antimicrobial approval system and on-the-spot education in a traumatic intensive care unit in Taiwan.

Publisher: published by Elsevier for the Taiwan Society of Microbiology Country of Publication: England NLM ID: 100956211 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1995-9133 (Electronic) Linking ISSN: 16841182 NLM ISO Abbreviation: J Microbiol Immunol Infect Subsets: MEDLINE

Publication: Feb. 2010- : Oxford, England : published by Elsevier for the Taiwan Society of Microbiology
Original Publication: Taipei, Taiwan : Chinese Society of Microbiology : Chinese Society of Immunology [and] : Infectious Diseases Society of the Republic of China,

Program Evaluation*; Anti-Infective Agents/*standards ; Drug Utilization/*standards ; Drug Utilization/*statistics & numerical data ; Inservice Training/*methods ; Intensive Care Units/*statistics & numerical data ; Medical Order Entry Systems/*statistics & numerical data; Anti-Infective Agents/economics ; Anti-Infective Agents/therapeutic use ; Cross Infection/drug therapy ; Cross Infection/mortality ; Cross Infection/prevention & control ; Drug Resistance, Bacterial ; Drug Utilization/economics ; Drug Utilization Review ; Female ; Hospital Mortality ; Hospitals ; Humans ; Infection Control/methods ; Infection Control/standards ; Infection Control/statistics & numerical data ; Inservice Training/standards ; Inservice Training/statistics & numerical data ; Intensive Care Units/standards ; Male ; Middle Aged ; Retrospective Studies ; Taiwan

Background/purpose: Inappropriate prescribing of antibiotics is a major health-care problem in intensive care units (ICUs). This study evaluates the impact of a direct hospital-wide computerized antimicrobial approval system (HCAAS) and on-the-spot education for practitioners in a neurosurgical ICU in Taiwan.
Methods: We retrospectively analyzed the medical records monthly of patients who were admitted to the neurosurgical ICU during a period of 7 years and 7 months. A pretest-post-test time series analysis, comparing the three periods: period I (no infectious disease (ID) physician), period II (part-time ID physicians), and period III (full-time ID physician). Antimicrobial consumption and expenditure, incidence of hospital-associated infections, prevalence of healthcare-associated bacterial isolates, in-hospital mortality rates, and indication of antibiotics usage were analyzed.
Results: Full-time ID physician can increase the consumption of narrow-spectrum antimicrobials (cefazolin, and cefuroxime), and decrease the consumptions of broad-spectrum antimicrobials (ceftazidime, cefepime, and vancomycin) compared to part-time ID physicians. From period I to period III, the expenditure of antimicrobials, incidence of hospital-associated pneumonia, and the in-hospital mortality rates (crude, sepsis-related, and overall infection-related mortality) decreased statistically. The prevalence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae, and Carbapenems-resistant Pseudomonas aeruginosa remained at low level after HCAAS implementation. From 2007 to 2009, the rational antibiotics usage continued to increase, resulting from to more prophylaxis and appropriate microbiologic proof, but less empiric antimicrobial therapy.
Conclusion: Implementation of HCAAS and long-term on-the-spot education by full-time ID physician can reduce antimicrobial consumption, cost, and improve inappropriate antibiotic usage whilst not compromising healthcare quality.
(Copyright © 2017. Published by Elsevier B.V.)

Keywords: Hospital-associated infections; Hospital-wide computerized antimicrobial approval system; ICU; On-the-spot education

0 (Anti-Infective Agents)

Date Created: 20171124 Date Completed: 20181126 Latest Revision: 20181202

20221213

10.1016/j.jmii.2017.10.004

29167061