Investigators in Japan Find Benefits of Earlier Antibiotic Stewardship Intervention

Implementing antibiotic stewardship intervention early on in a hospital stay offers health and cost benefits to patients, according to a new study conducted by investigators in Japan.

The World Health Organization (WHO) calls antibiotic resistance fueled by the misuse of antibiotics one of today’s biggest threats to global health, food security, and development. Over time, bacterial pathogens that have grown resistant to antibiotics due to overuse and inappropriate prescribing of the drugs have led to hard-to-treat infections with longer hospital stays, higher medical costs, and increased mortality. In response, health officials around the world have promoted antibiotic stewardship, encouraging interventions designed to promote the optimal use of antibiotic agents, including drug choice, dosing, route, and duration of administration. With few new antibiotics in the research and development pipeline, antibiotic stewardship is key to ensuring that currently available antibiotics remain effective.

At the recent United Nations (UN) General Assembly, a collective of world leaders from both the public and private sector pledged to fight antibiotic and antimicrobial resistance (AMR) through the AMR Challenge, a new initiative to combat the global health threat. With more than 100 governments, companies, and organizations on board, the government of Japan pledged to help create an AMR surveillance system for Asian countries. In a recent study published in the International Journal of Infectious Diseases, investigators from Japan’s Fukuoka University Hospital looked at the effects of early intervention by an antibiotic stewardship team on antibiotic use, antibiotic resistance rates, and patients’ clinical outcomes

The retrospective study was conducted from April 2013 to March 2016 in a 915-bed, university-affiliated, tertiary hospital, following the hospital’s initiation of a policy wherein an antibiotic stewardship program team would perform weekly interventions for patients using carbapenems and anti-MRSA (methicillin-resistant Staphylococcus aureus) agents for more than 14 days. In the study, investigators compared the effects of 3 study periods (SP). In SP1, patients received anti-MRSA agents and carbapenems for 14 or more days. In SP2, patients received specific antibiotics for 14 or more days. SP3 included all patients treated with specific antimicrobials, regardless of the duration of use.

As a result of the study, the timing of antibiotic stewardship intervention shortened from an average of 15.5 days after administration in SP1 to 4.2 days in SP3, while the antimicrobial use density of carbapenems and piperacillin-tazobactam decreased significantly. Costs of specific antimicrobials decreased from $1,080,000 in SP1 to $944,000 in SP2 and $763,000 in SP3. In addition, the rates of carbapenem resistance among Pseudomonas aeruginosa isolates showed a significant reduction from 16.2% in SP2 to 8.7% in SP3.

“In the present study, we compared the effect of an earlier intervention in a stepwise manner without changing the weekly interval of intervention. As a result, antimicrobial use, the long-term use rate, the rates of drug resistance in P aeruginosa isolates, and the cost were reduced,” the authors write. “On the other hand, the length of stay and mortality rate did not change to a statistically significant extent and there was no recurrence within 7 days after the end of antimicrobial treatment among the intervention cases, suggesting the validity of our intervention.”

The authors added that there was a possibility that fluctuation of antimicrobial resistance rates could be influenced by additional factors, such as infection control, and highlight that early intervention was not associated with disadvantages such as infection relapse.