Impact of an Antimicrobial Stewardship Policy on Appropriate Antimicrobial use at Phrae Hospital
Abstract
Background: Inappropriate use of antimicrobial contributes to antimicrobial resistance and increased healthcare costs. Drug Use Evaluation (DUE) has been widely implemented as part of antimicrobial stewardship programs to promote rational antimicrobial use in hospital settings.
Objective: To evaluate the impact of implementing a Drug Use Evaluation (DUE) system on antimicrobial consumption and expenditure in a hospital.
Study design: A quasi-experimental study using an interrupted time series (ITS) design with segmented regression analysis was conducted to assess changes in antimicrobial utilization before and after implementation of the DUE system. Monthly data were collected over a 24-month period, including 12 months before and 12 months after the intervention. Antimicrobial consumption was measured as defined daily doses per 1,000 bed-days (DDD/1,000 bed-days), and antimicrobial expenditure was calculated as monthly costs in Thai Baht.
Results: Following the implementation of the DUE system, significant decreases in the trend of antimicrobial consumption were observed for meropenem (β₃=−3.47, p<0.001), piperacillin/tazobactam (β₃=−2.50, p=0.002), and fosfomycin (β₃=−0.98, p<0.001). In contrast, ampicillin/sulbactam showed a significant increasing trend after the intervention (β₃=0.42, p=0.021). No significant changes in trend were observed for imipenem, azithromycin, colistin, or cefoperazone/sulbactam. Overall, the implementation of the DUE system was associated with reduced use of several broad-spectrum antimicrobial and decreased antimicrobial expenditure.
Conclusion: Implementation of a DUE system was associated with changes in antimicrobial prescribing patterns, particularly reductions in the use of broad-spectrum antimicrobial. These findings highlight the potential role of DUE as an effective antimicrobial stewardship strategy to promote rational antimicrobial use and reduce healthcare costs.
Keywords: Drug Use Evaluation, Antimicrobial Stewardship, Interrupted Time Series, Antimicrobial Consumption, Antimicrobial Resistance
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