2021 Volume 58 Issue 1 Pages 6-11
Implementation of the Antimicrobial Stewardship Program (ASP), which provides guidance on antimicrobial use, is expected to reduce the prevalence of drug-resistant bacteria, reduce medical costs, and provide education to healthcare providers. We evaluated the effects of introducing the ASP in the hematology and oncology wards of our institute in September 2014. As part of this program, we aimed to administer cefepime (CFPM) for febrile neutropenia (FN) and restrict the use of tazobactam/piperacillin (TAZ/PIPC) and meropenem (MEPM). We retrospectively evaluated the day of therapy (DOT)/1,000 patient-days, antibiogram changes, and numbers of deaths caused by infectious diseases within the period from October 2010 to August 2018, divided into three phases: pre-ASP introduction, transitional phase, and mature phase. Compared with the pre-ASP introduction phase, the mature-phase DOT for CFPM increased 3.95 times; in contrast, the mature-phase DOT for TAZ/PIPC and MEPM decreased 0.34 and 0.13 times, respectively (p<0.01). The activity of CFPM against Gram-negative bacteria was about 70%. The cases in which CFPM was ineffective were presumably due to naturally resistant β-lactamase-producing bacteria. The susceptibility of Pseudomonas aeruginosa to TAZ/PIPC and MEPM was below 90% in the transient phase, but it increased to over 90% in the mature phase. Antibiotic selection was not found to affect the number of deaths caused by infectious diseases. Significant reductions in MEPM and TAZ/PIPC use for febrile neutropenia did not increase the number of cases of serious infectious diseases and did not affect infectious disease mortality. The usefulness of ASP, in close cooperation with infectious disease specialists, was demonstrated in our pediatric hematology and oncology wards.
