Impact of an Infectious Disease Specialist on an Antimicrobial Stewardship Program at a Resource-Limited, Non-Academic Community Hospital in Korea
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Data Collection
2.2. Amount of Antibiotic Consumption
2.3. The Intervention
2.4. Statistical Analysis
3. Results
3.1. Clinical Characteristics of Patients
3.2. Amount of Antibiotic Consumption
3.3. Incidence of MDRO Acquisition
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Methicillin-Resistant Staphylococcus aureus | Multidrug-Resistant Pseudomonas aeruginosa | Multidrug-Resistant Acinetobacter baumannii | ||||||
---|---|---|---|---|---|---|---|---|---|
One Year before Intervention (n = 217) | One Year after Intervention (n = 145) | p-value | One Year before Intervention (n = 33) | One Year after Intervention (n = 44) | p-value | One Year before Intervention (n = 118) | One Year after Intervention (n = 21) | p-value | |
Age, years (IQR) | 77 ± 13.6 | 75 ± 15.98 | 0.184 | 77 ± 13.33 | 73 ± 15.13 | 0.26 | 76 ± 14.26 | 77 ± 11.34 | 0.73 |
Male, n (%) | 129 (59.5) | 97 (66.9) | 0.152 | 16 (48.5) | 25 (56.8) | 0.468 | 38 (32.2) | 7 (33.3) | 0.919 |
Antibiotic use in the past 30 days, n (%) | 166 (76.5) | 95 (65.5) | 0.065 | 27 (81.8) | 40 (90.9) | 0.291 | 107 (90.7) | 18 (85.7) | 0.536 |
Comorbidities, n (%) | |||||||||
Diabetes | 73 (33.6) | 41 (28.3) | 0.282 | 13 (39.4) | 10 (22.7) | 0.114 | 37 (31.4) | 8 (38.1) | 0.543 |
Solid cancer | 34 (15.7) | 28 (19.3) | 0.278 | 6 (18.2) | 7 (15.9) | 0.792 | 21 (17.8) | 8 (38.1) | 0.044 |
Hematologic malignancy | 1 (0.5) | 2 (1.4) | 0.567 | 1 (3.0) | 1 (2.3) | >0.999 | 1 (0.9) | 0 (0.0) | >0.999 |
Solid organ transplantation | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - |
Hematologic stem cell transplantation | 0 (0.0) | 1 (0.7) | 0.401 | 0 (0.0) | 1 (2.3) | >0.999 | 0 (0.0) | 0 (0.0) | - |
Rheumatologic disease | 4 (1.8) | 2 (1.4) | >0.999 | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - |
Cardiovascular disease | 139 (64.1) | 96 (66.2) | 0.674 | 20 (60.6) | 28 (63.6) | 0.786 | 73 (61.9) | 18 (85.7) | 0.034 |
Chronic obstructive pulmonary disease | 33 (15.2) | 26 (17.9) | 0.492 | 2 (6.1) | 8 (18.2) | 0.174 | 18 (15.3) | 5 (23.8) | 0.344 |
Renal Disease | 60 (27.7) | 42 (29.0) | 0.785 | 6 (18.2) | 7 (15.9) | 0.792 | 30 (25.4) | 6 (28.6) | 0.762 |
Liver disease | 45 (20.7) | 32 (22.1) | 0.762 | 4 (12.1) | 9 (20.5) | 0.334 | 18 (15.3) | 3 (14.3) | >0.999 |
HIV infection | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - |
Hemodialysis | 16 (7.4) | 10 (6.9) | 0.863 | 2 (6.1) | 6 (13.6) | 0.454 | 8 (6.8) | 2 (9.5) | 0.648 |
Neutropenia | 0 (0.0) | 1 (0.7) | 0.401 | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - |
Steroid therapy | 16 (7.4) | 10 (6.9) | >0.999 | 2 (6.1) | 2 (4.6) | 0.347 | 14 (11.9) | 2 (9.5) | >0.999 |
Immunosuppressive therapy | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - |
Chemotherapy | 0 (0.0) | 3 (2.1) | 0.064 | 0 (0.0) | 1 (2.3) | >0.999 | 0 (0.0) | 0 (0.0) | - |
Radiotherapy | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - | 0 (0.0) | 0 (0.0) | - |
Antibiotics | Coefficient | Standard Error | p-Value |
---|---|---|---|
Aminoglycosides | |||
Baseline level | 22.0256 | 0.9929 | |
Baseline trend | −0.3305 | 0.0695 | <0.001 |
Level change after intervention | 0.8123 | 1.7243 | 0.641 |
Trend change after intervention | −0.2064 | 0.2089 | 0.331 |
1st/2nd generation cephalosporins | |||
Baseline level | 101.9253 | 4.6246 | |
Baseline trend | −0.6535 | 0.3237 | 0.052 |
Level change after intervention | 1.9191 | 8.0315 | 0.813 |
Trend change after intervention | 1.891 | 0.9732 | 0.061 |
3rd/4th generation cephalosporins | |||
Baseline level | 177.211 | 13.0193 | |
Baseline trend | 1.7935 | 0.9112 | 0.058 |
Level change after intervention | 11.108 | 22.6103 | 0.627 |
Trend change after intervention | −8.4598 | 2.7399 | 0.004 |
Ceftazidime/cefepime | |||
Baseline level | 66.3764 | 8.7921 | |
Baseline trend | 0.5003 | 0.6153 | 0.422 |
Level change after intervention | −7.0211 | 15.269 | 0.649 |
Trend change after intervention | −5.663 | 1.8503 | 0.004 |
Carbapenems | |||
Baseline level | 39.3779 | 4.1486 | |
Baseline trend | 0.4704 | 0.2903 | 0.115 |
Level change after intervention | −16.1077 | 7.2047 | 0.033 |
Trend change after intervention | −2.0287 | 0.8731 | 0.027 |
Glycopeptides | |||
Baseline level | 35.0324 | 2.6622 | |
Baseline trend | 0.1151 | 0.1863 | 0.541 |
Level change after intervention | −12.2869 | 4.6233 | 0.012 |
Trend change after intervention | −0.885 | 0.5602 | 0.124 |
Penicillins | |||
Baseline level | 140.8157 | 12.7416 | |
Baseline trend | 0.5614 | 0.8917 | 0.533 |
Level change after intervention | −46.7517 | 22.128 | 0.043 |
Trend change after intervention | 4.2492 | 2.6814 | 0.123 |
Fluoroquinolones | |||
Baseline level | 115.0862 | 6.0155 | |
Baseline trend | −1.8856 | 0.421 | <0.001 |
Level change after intervention | 4.1865 | 10.447 | 0.691 |
Trend change after intervention | 1.0813 | 1.2659 | 0.399 |
Other antibiotics | |||
Baseline level | 64.8456 | 4.395 | |
Baseline trend | 0.1295 | 0.3076 | 0.677 |
Level change after intervention | −16.0924 | 7.6328 | 0.043 |
Trend change after intervention | 0.185 | 0.9249 | 0.843 |
Total antibiotics | |||
Baseline level | 696.3197 | 31.5014 | |
Baseline trend | 0.2003 | 2.2046 | 0.928 |
Level change after intervention | −73.2129 | 54.7076 | 0.19 |
Trend change after intervention | −4.1733 | 6.6293 | 0.536 |
Multidrug-Resistant Organisms | Coefficient | Standard Error | p-Value |
---|---|---|---|
Methicillin-resistant Staphylococcus aureus | |||
Baseline level | 1.05 | 0.10 | |
Baseline trend | 0.03 | 0.01 | 0.001 |
Level change after intervention | −0.71 | 0.18 | <0.001 |
Trend change after intervention | −0.02 | 0.02 | 0.439 |
Multidrug-resistant Pseudomonas aeruginosa | |||
Baseline level | 0.19 | 0.06 | |
Baseline trend | 0.002 | 0.004 | 0.628 |
Level change after intervention | 0.21 | 0.10 | 0.035 |
Trend change after intervention | −0.02 | 0.01 | 0.082 |
Multidrug-resistant Acinetobacter baumannii | |||
Baseline level | 0.85 | 0.13 | |
Baseline trend | −0.01 | 0.01 | 0.569 |
Level change after intervention | −0.62 | 0.24 | 0.014 |
Trend change after intervention | 0.02 | 0.03 | 0.588 |
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Share and Cite
Kim, Y.C.; Kim, E.J.; Heo, J.Y.; Choi, Y.H.; Ahn, J.Y.; Jeong, S.J.; Ku, N.S.; Choi, J.Y.; Yeom, J.-s.; Kim, H.Y. Impact of an Infectious Disease Specialist on an Antimicrobial Stewardship Program at a Resource-Limited, Non-Academic Community Hospital in Korea. J. Clin. Med. 2019, 8, 1293. https://doi.org/10.3390/jcm8091293
Kim YC, Kim EJ, Heo JY, Choi YH, Ahn JY, Jeong SJ, Ku NS, Choi JY, Yeom J-s, Kim HY. Impact of an Infectious Disease Specialist on an Antimicrobial Stewardship Program at a Resource-Limited, Non-Academic Community Hospital in Korea. Journal of Clinical Medicine. 2019; 8(9):1293. https://doi.org/10.3390/jcm8091293
Chicago/Turabian StyleKim, Yong Chan, Eun Jin Kim, Jung Yeon Heo, Young Hwa Choi, Jin Young Ahn, Su Jin Jeong, Nam Su Ku, Jun Yong Choi, Joon-sup Yeom, and Ha Yan Kim. 2019. "Impact of an Infectious Disease Specialist on an Antimicrobial Stewardship Program at a Resource-Limited, Non-Academic Community Hospital in Korea" Journal of Clinical Medicine 8, no. 9: 1293. https://doi.org/10.3390/jcm8091293