Long-Term Effects of Phased Implementation of Antimicrobial Stewardship in Academic ICUs: 2007-2015

摘要: OBJECTIVES Antimicrobial stewardship is advocated to reduce antimicrobial resistance in ICUs by reducing unnecessary consumption. Evidence has been limited short, single-center studies. We evaluated whether could consumption and costs. DESIGN conducted a phased, multisite cohort study of quality improvement initiative. SETTING was implemented four academic Toronto, Canada beginning February 2009 ending July 2012. PATIENTS All patients admitted each ICU from January 1, 2007, December 31, 2015, were included. INTERVENTIONS delivered using in-person coaching pharmacists physicians three five times weekly, supplemented with unit-based performance reports. Total monthly (measured defined daily doses/100 patient-days) costs (Canadian dollars/100 before after implementation measured. MEASUREMENTS AND MAIN RESULTS A total 239,123 patient-days (57,195 patients) analyzed, 148,832 following introduction stewardship. Antibacterial use decreased 120.90 110.50 dose/100 (adjusted intervention effect -12.12 patient-days; 95% CI, -16.75 -7.49; p < 0.001) antifungal 30.53 27.37 -3.16 -8.33 0.04; = 0.05). Monthly $3195.56 $1998.59 -$642.35; -$905.85 -$378.84; unchanged $1771.86 $2027.54 -$355.27; -$837.88 $127.33; 0.15). Mortality remained unchanged, no consistent effects on candidemia. CONCLUSIONS plus audit feedback associated sustained improvements cost. high or expenditure should consider implementing programs.