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Evaluation of an Antimicrobial Stewardship Program in Light of the Goals of the National Antimicrobial Resistance Action Plan at a Children's Hospital
1)Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2)Division of Microbiology, Department of Laboratory, Tokyo Metropolitan Children's Medical Center, 3)Division of General Pediatrics, Aichi Children's Health and Medical Center, 4)Division of Pediatric Infectious Diseases, Shizuoka Children's Hospital
Yuho HORIKOSHI1), Hiroshi HIGUCHI2), Yuta AIZAWA1), Mihoko ISOGAI1), Kenta ITO3) & Takayo SHOJI4)
(Received January 20, 2017)
(Accepted June 30, 2017)
Key words: antimicrobial stewardship program, antimicrobial resistance, national action plan, child

Antimicrobial resistance (AMR) is an increasingly serious global concern for medicine, public health, and the economy. In 2016, the Japanese government announced a national AMR action plan targeting the reduction of antimicrobial consumption and the AMR rate in pathogenic bacteria. Tokyo Metropolitan Children's Medical Center implemented a coordinated antimicrobial stewardship program (ASP) from 2011 including preauthorization of restricted antimicrobial agents, restrictive reporting on susceptibility to broad spectrum antimicrobials, standardization of infection treatment and prophylaxis, real-time therapeutic drug monitoring, and education on infectious diseases. The study aimed to assess the hospital's current ASP according to the outcome indicators of the National AMR Action Plan. Changes in the antimicrobial consumption rate were measured by days of therapy per 1,000 patient-days and the number of prescriptions per 1,000 visits in fiscal years 2010 and 2015. AMR rates excluding duplicate data were extracted from isolates in fiscal year 2015. The changes in the inpatient and outpatient antimicrobial consumption rate were -8.0% and -27.6%, respectively (goal: -33.3%). The changes in the consumption rate for all intravenous and restricted intravenous agents were+5.0% and -23.0%, respectively (goal: -20.0%). The changes in the inpatient and outpatient consumption rate of restricted oral agents were -73.9% and -91.2%, respectively (goal: -33.3%). The changes in oral cephalosporins, macrolides, and fluoroquinolones consumption were -49.6%, -54.9% and -85.7%, respectively (goal: -50%). The non-susceptibility rate of Streptococcus pneumoniae to penicillin was 47.8% (goal: ≤15%). The methicillin resistance rate of Staphylococcus aureus was 39.4% (goal: ≤20%). The non-susceptibility rate of Escherichia coli to levofloxacin was 29.1% (goal: ≤25%). The non-susceptibility rates of Pseudomonas aeruginosa, E. coli, and Klebsiella pneumoniae to imipenem were 9.2% (goal: ≤10%), 0.8% (goal: 0.1-0.2%), and 0% (goal: 0.1-0.2%), respectively. Oral cephalosporins, macrolides, and fluoroquinolones consumption rates closely approached the AMR action plan goals due to the restriction of oral 3rd cephalosporins and fluoroquinolones. Although oral macrolides use was unrestricted, improper prescription for viral infections was reduced through education. Consumption of restricted intravenous agents was successfully decreased. However, consumption of the intravenous agents did not decrease due to an increase in the use of nonrestricted intravenous agents. Further assessment of the unrestricted use of intravenous agents is needed. The AMR rate of S pneumoniae, S. aureus, and enterobacteriaceae were also influenced by the transmissions and antimicrobial pressures on both the other hospitals and clinics or at the level of the community. An ASP conducted by a single children's hospital had a limited impact on reducing the AMR rate of these pathogens, as AMR could emerge elsewhere. The AMR rate of P. aeruginosa to imipenem can be reduced or sustained by establishing an ASP at medical facilities. Judicious use of antimicrobials in all medical facilities including primary care and community hospitals is critical for preventing the emergence of AMR.

[ Kansenshogaku Zasshi 91: 936-942, 2017 ]

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