Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.
Abstract
Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.
참고문헌 (49)
- Bell BG, "A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance", BMC Infect Dis, 14, pp.13~ (2014)
- Slimings C, "Antibiotics and hospital-acquired Clostridium difficile infection : update of systematic review and meta-analysis", J Antimicrob Chemother, 69, pp.881~891 (2014)
- Sanyaolu A, "Candida auris : an overview of the emerging drug-resistant fungal infection", Infect Chemother, 54, pp.236~246 (2022)
- Cheong T, "Quantitative evaluation of the economic impact of antimicrobial resistance on the treatment of community-acquired acute pyelonephritis in Korea", Infect Chemother, 54, pp.456~469 (2022)
- Magill SS, "Assessment of the appropriateness of antimicrobial use in US hospitals", JAMA Netw Open, 4, pp.e212007~ (2021)
- Gürtler N, "Appropriateness of antimicrobial prescribing in a Swiss tertiary care hospital : a repeated point prevalence survey", Swiss Med Wkly, 149, pp.w20135~ (2019)
- Park SY, "Appropriateness of antibiotic prescriptions during hospitalization and ambulatory care : a multicentre prevalence survey in Korea", J Glob Antimicrob Resist, 29, pp.253~258 (2022)
- Kim YC, "Prescriptions patterns and appropriateness of usage of antibiotics in non-teaching community hospitals in South Korea : a multicentre retrospective study", Antimicrob Resist Infect Control, 11, pp.40~ (2022)
- Society for Healthcare Epidemiology of America, "Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America(SHEA), the Infectious Diseases Society of America(IDSA), and the Pediatric Infectious Diseases Society(PIDS)", Infect Control Hosp Epidemiol, 33, pp.322~327 (2012)
- García-Rodríguez JF, "Meropenem antimicrobial stewardship program : clinical, economic, and antibiotic resistance impact", Eur J Clin Microbiol Infect Dis, 38, pp.161~170 (2019)
- Baur D, "Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection : a systematic review and meta-analysis", Lancet Infect Dis, 17, pp.990~1001 (2017)
- Al-Omari A, "The impact of antimicrobial stewardship program implementation at four tertiary private hospitals : results of a five-years pre-post analysis", Antimicrob Resist Infect Control, 9, pp.95~ (2020)
- Barlam TF, "The state of antibiotic stewardship programs in 2021 : The perspective of an experienced steward", Antimicrob Steward Healthc Epidemiol, 1, pp.e20~ (2021)
- "Contained and controlled: the UK’s 20-year vision for antimicrobial resistance" (2019)[URL]
- Kim Y, "Trends in national pharmaceutical expenditure in Korea during 2011-2020", Infect Chemother, 55, pp.237~246 (2023)
- Division of Antimicrobial Resistance Control, Bureau of Healthcare Safety and Immunication, Korea Disease Control and Prevention Agency, "The Integrated Operation Guidelines for Antimicrobial Stewardship Program (ASP)", Korea Disease Control and Prevention Agency, ~ (2023)
- "Core elements of hospital antibiotic stewardship programs" (2019)[URL]
- Cheong HS, "Developing core elements and checklist items for implementing antimicrobial stewardship programs in Korean general hospitals : a modified Delphi survey", Infect Chemother, 55, pp.59~68 (2023)
- Schaut M, "Integrated antibiotic clinical decision support system(CDSS)for appropriate choice and dosage : an analysis of retrospective data", Germs, 12, pp.203~213 (2022)
- Kwon MK, "Antibiotics use patterns in end-of-life cancer patients and medical staff’s perception of antimicrobial stewardship programs", Korean J Intern Med, 38, pp.758~768 (2023)
- Choi H, "Bloodstream infections in patients with hematologic diseases : causative organisms and factors associated with resistance", Infect Chemother, 54, pp.340~352 (2022)
- Kwon JC, "Epidemiology and clinical features of bloodstream infections in hematology wards : one year experience at the catholic blood and marrow transplantation center", Infect Chemother, 45, pp.51~61 (2013)
- Yoon YK, "Trends of antibiotic consumption in Korea according to national reimbursement data (2008-2012): a population-based epidemiologic study", Medicine(Baltimore), 94, pp.e2100~ (2015)
- Rybak MJ, "Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections : a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists", Am J Health Syst Pharm, 77, pp.835~864 (2020)
- Choi HJ, "Five-year decreased incidence of surgical site infections following gastrectomy and prosthetic joint replacement surgery through active surveillance by the Korean Nosocomial Infection Surveillance System", J Hosp Infect, 93, pp.339~346 (2016)
- Jung YJ, "Aerosolized antibiotics in the treatment of hospital-acquired pneumonia", ventilator-associated pneumonia, 2022, pp.37, 1~12
- Kim B, "Significance of the regular publication of statistics on national health indicators in academic journals and the prospects of Korea National Antimicrobial Use Analysis System(KONAS)", Infect Chemother, 55, pp.306~307 (2023)
- Little P, "Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections : a multinational, cluster, randomised, factorial, controlled trial", Lancet, 382, pp.1175~1182 (2013)
- Park SM, "Impact of intervention by an antimicrobial stewardship team on conversion from intravenous to oral fluoroquinolones", Infect Chemother, 49, pp.31~37 (2017)
- Song YJ, "Impact of an antimicrobial stewardship program on unnecessary double anaerobic coverage prescription", Infect Chemother, 47, pp.111~116 (2015)
- Kim B, "Professional status of infectious disease specialists in Korea : a nationwide survey", J Korean Med Sci, 37, pp.e320~ (2022)
- Park SY, "Human resources required for antimicrobial stewardship activities for hospitalized patients in Korea", Infect Control Hosp Epidemiol, 41, pp.1429~1435 (2020)
- Lee MJ, "Status of antimicrobial stewardship programmes in Korean hospitals including small to medium-sized hospitals and the awareness and demands of physicians : a nationwide survey in 2020", J Glob Antimicrob Resist, 26, pp.180~187 (2021)
- Kim B, "Current status of antimicrobial stewardship programmes in Korean hospitals : results of a 2018 nationwide survey", J Hosp Infect, 104, pp.172~180 (2020)
- Lee HJ, "Urgent need for novel antibiotics in Republic of Korea to combat multidrug-resistant bacteria", Korean J Intern Med, 37, pp.271~280 (2022)
- Park SY, "Developing a framework for regular and sustainable qualitative assessment of antibiotic use in Korean medical institutions : a Delphi study", Antimicrob Resist Infect Control, 12, pp.114~ (2023)
- Park SY, "Current status and prospect of qualitative assessment of antibiotics prescriptions", Infect Chemother, 54, pp.599~609 (2022)
- Kim CJ, "Current status of antibiotic stewardship and the role of biomarkers in antibiotic stewardship programs", Infect Chemother, 54, pp.674~698 (2022)
- Lee H, "Procalcitonin as a biomarker of infectious diseases", Korean J Intern Med, 28, pp.285~291 (2013)
- Kim YK, "Procalcitonin in bloodstream infections : beyond its role as a marker of clinical algorithm to reduce antimicrobial overuse", Korean J Intern Med, 33, pp.78~80 (2018)
- Park DW, "Implementation of procalcitonin in antibiotic stewardship : derivation of a consensus algorithm for procalcitonin use in clinical practice", Infect Chemother, 54, pp.621~636 (2022)
- Kim B, "Ten-year trends in antibiotic usage at a tertiary care hospital in Korea, 2004 to 2013", Korean J Intern Med, 35, pp.703~713 (2020)
- Shin DH, "Stepwise expansion of antimicrobial stewardship programs and its impact on antibiotic use and resistance rates at a tertiary care hospital in Korea", Microbiol Spectr, 10, pp.e0033522~ (2022)
- Chun JY, "Impact of a computerised clinical decision support system on vancomycin loading and the risk of nephrotoxicity", Int J Med Inform, 149, pp.104403~ (2021)
- Song JU, "The impact of antimicrobial de-escalation therapy in culture-negative pneumonia : a systematic review and meta-analysis", Korean J Intern Med, 38, pp.704~713 (2023)
- Amábile-Cuevas CF, "Myths and misconceptions around antibiotic resistance : time to get rid of them", Infect Chemother, 54, pp.393~408 (2022)
- Kim B, "A survey of antimicrobial stewardship programs in Korea, 2015", J Korean Med Sci, 31, pp.1553~1559 (2016)
- Kim HS, "Development of a roadmap for the antimicrobial usage monitoring system for medical institutions in Korea : a Delphi study", Infect Chemother, 54, pp.483~492 (2022)
- Maeda M, "Essential human resources for antimicrobial stewardship teams in Japan : Estimates from a nationwide survey conducted by the Japanese Society of Chemotherapy", J Infect Chemother, 25, pp.653~656 (2019)