Table 1.
Demographics of patients who received antimicrobial injection, antimicrobial consumption, incidence of antibiotic-resistant bacteria before and after implementation of antimicrobial stewardship
| Period 1 before intervention (n = 6251) | Period 2 initial intervention (n = 6348) | Period 3 active intervention (n = 6507) | p-value Period 1 vs. Period 3 | |
|---|---|---|---|---|
| Gender (male/female) (n) | 3334/2917 | 3417/2931 | 3466/3041 | 0.66† |
| Age (years)* | 54 (23.2) | 55 (22.5) | 56(22.6) | < 0.01†† |
| Operation (with/without) (%) | 4140/2111 (66.2%) | 4300/2048 (67.7%) | 3909/2598 (60.1%) | < 0.01† |
| Antibiotic consumption§ | ||||
| Penicillins | 49.8 (37.8–65.6) | 56.4 (34.8–68.5) | 47.5 (29.4–62.8) | 0.49 |
| First-generation cephalosporins | 42.5 (35.9–45.7) | 41.7 (36.2–49.8) | 44.0 (41.1–47.2) | 0.13 |
| Second-generation cephalosporins | 13.1 (11.5–18.3) | 12.1 (10.9–14.2) | 12.0 (9.2–14.4) | 0.03 |
| Third-generation cephalosporins | 24.2 (18.8–31.7) | 25.1 (16.6–34.1) | 23.7 (16.1–33.8) | 0.82 |
| Fourth-generation cephalosporins | 15.7 (9.7–22.9) | 15.2 (9.5–22.1) | 16.0 (9.9–22.8) | 0.73 |
| Carbapenems | 27.8 (23.5–44.2) | 25.7 (18.1–34.7) | 23.3 (15.6–35.1) | 0.003 |
| Anti-MRSA agents | 13.6 (9.2–19.2) | 15.4 (11.3–25.7) | 15.5 (10.3–22.9) | 0.13 |
| Quinolones | 4.6 (1.7–8.6) | 4.2 (1.6–8.5) | 3.7 (0.4–6.4) | 0.09 |
| Aminoglycosides | 3.9 (2.4–5.0) | 4.0 (1.7–7.5) | 1.4 (0.8–2.6) | < 0.001 |
| Others | 10.2 (8.1–13.7) | 7.6 (6.1–8.6) | 4.6 (2.0–6.9) | < 0.001 |
| Total | 210.3 (187.8–228.5) | 209.3 (165.9–230.6) | 192.6 (170.6–208.5) | 0.003 |
| Resistant bacteria** | ||||
| No. of patients from whom MRSA was isolated/no. of patients from whom Staphylococcus aureus was isolated | 172/361 (47.6%) | 152/370 (41.1%) | 151/382 (39.5%) | 0.026 |
| No. of patients from whom each pathogen was isolated/no. of patients from whom Gram-negative bacteria were isolated | ||||
| Acinetobacter baumannii | 59/1026 (5.8%) | 67/1024 (6.5%) | 56/982 (5.7%) | 0.963 |
| Burkholderia cepacia | 1/1026 (0.1%) | 2/1024 (0.2%) | 1/982 (0.1%) | 0.498 |
| Citrobacter species | 36/1026 (3.5%) | 29/1024 (2.8%) | 27/982 (2.7%) | 0.329 |
| Enterobacter cloacae | 81/1026 (7.9%) | 92/1024 (9.0%) | 64/982 (6.5%) | 0.233 |
| Pseudomonas aeruginosa | 134/1026 (13.1%) | 125/1024 (12.2%) | 156/982 (15.9%) | 0.072 |
| Serratia marcescens | 38/1026 (3.7%) | 30/1024 (2.9%) | 20/982 (2.0%) | 0.026 |
| Stenotrophomonas maltophilia | 38/1026 (3.7%) | 44/1024 (4.3%) | 40/982 (4.1%) | 0.668 |
| No. of patients from whom resistant P. aeruginosa was isolated/no. of patients from whom P. aeruginosa was isolated | ||||
| Amikacin | 1/134 (0.7%) | 2/125 (1.6%) | 0/156 (0%) | 0.939 |
| Ceftazidime | 9/134 (6.7%) | 6/125 (4.8%) | 5/154 (3.2%) | 0.784 |
| Imipenem/cilastatin | 11/134 (8.2%) | 7/125 (5.6%) | 15/155 (9.7%) | 0.663 |
| Levofloxacin | 8/134 (6.0%) | 8/125 (6.4%) | 8/156 (5.1%) | 0.956 |
| Piperacillin | 6/134 (4.5%) | 3/125 (2.4%) | 5/156 (3.2%) | 0.797 |
*
Data indicate the mean (standard deviation).
†
χ2 test
††
Mann–Whitney U-test.
§
Values are antimicrobial use densities expressed as DDD/1000 patient-days, median (range). p-values are for comparisons of period 3 with period 1 by Mann–Whitney U-test.
**
Data were statistically compared by χ2 test.