Effects of a comprehensive antimicrobial stewardship program in a surgical intensive care unit.
OBJECTIVES
We evaluated the effects of a comprehensive antimicrobial stewardship program (ASP) in a surgical intensive care unit (SICU).


METHODS
The ASP was implemented from March 2018 to February 2019 at an SICU in a teaching hospital. An infectious disease physician and a pharmacist visited the SICU 3 times per week for prospective audit and feedback. Outcomes were compared between the ASP period and the same months in the preceding year (pre-ASP period). The primary outcome measure was the use of anti-pseudomonal beta-lactams (APBL). Appropriate antimicrobial de-escalation and ICU mortality rates were also compared.


RESULTS
A total of 182 and 149 patients were included in the study for the pre-ASP and ASP periods, respectively. Although disease severity was higher in the ASP group (septic shock 39.0% in pre-ASP vs 65.1% in ASP group, P<0.001), the use of APBL as a definitive treatment was lower during ASP (68.7% vs 57.7%, OR 0.62, 95% CI 0.40-0.98). Appropriate antimicrobial de-escalation improved (63.2% vs 94.6%, P<0.001). ICU mortality was comparable (7.7% vs 7.4%) and significantly lower during the ASP, after adjustment (adjusted OR 0.41, 95% CI 0.18-0.92, P=0.032).


CONCLUSIONS
A comprehensive ASP decreased the use of APBL and was associated with improved patient outcomes.
['Kim|Si-Ho|SH|', 'Yoon|Jin Gu|JG|', 'Park|Hyo Jung|HJ|', 'Won|Hojeong|H|', 'Ryoo|Sung Suk|SS|', 'Choi|Eunsil|E|', 'Park|Eun-Kyung|EK|', 'Huh|Kyungmin|K|', 'Park|Chi-Min|CM|']
D000900:Anti-Bacterial Agents D000890:Anti-Infective Agents D000073602:Antimicrobial Stewardship D003422:Critical Care D006801:Humans D007362:Intensive Care Units
Antimicrobial stewardship Mortality Critical care Drug resistance Microbial