Effect of Gradual Implementation of Supportive Measures for Appropriate Use of Antimicrobial Agents

Abstract

  Management of multidrug-resistant organisms in the healthcare setup remains a significant problem. Since the formation of the infection control team (ICT) at our hospital in August 2004, supportive measures for the appropriate use of antimicrobial agents are being implemented gradually. Here we describe the measures implemented and discuss the outcomes and assessments of our system. A system has been implemented for reporting the use of specific intravenous antimicrobial agents (intravenous anti-methicillin-resistant Staphylococcus aureus agents, intravenous carbapenems, and intravenous fluoroquinolones) since 2007. This system was linked to computerized ordering systems. These supportive measures were implemented gradually. The ICT antimicrobial agents monitoring program was introduced in 2010 as a method for intervening more positively in treatment. As an index of the effectiveness of these measures, changes in the amount of carbapenems used (in vials), duration of administration, proportion of carbapenem-sensitive P. aeruginosa cases, and incidence of multidrug-resistant P. aeruginosa (MDRP) were investigated. The amount of carbapenems used decreased from 1277 vials (November 2004) to 327 vials (June 2010), and the duration of carbapenem administration decreased from 8.40 days (2006) to 5.97 days (2010). In addition, the proportion of meropenem-sensitive P. aeruginosa cases increased from 72% (2008) to 90% (2011) and the annual incidence of MDRP decreased from 28 (2008) to 1 (2011). By ensuring the gradual implementation of these supportive measures, we were able to increase awareness regarding the appropriate use of antimicrobial agents among medical professionals. These measures also helped in increasing the proportion of meropenem-sensitive P. aeruginosa cases and remarkably decreased the annual incidence of MDRP. Based on these findings, we want to promote intervention for appropriate use of high quality antimicrobial agents to continuously support the effective treatment of infectious diseases.