3차병원 중환자실 내 전향적 감사와 피드백을 통한 항생제 사용 중재 효과

Abstract

Background: The implementation of antibiotic stewardship program (ASP) has been encouraged in developed countries in response to increasing antibiotic resistance. However, the implementation of ASP has been limited owing to a lack of manpower and awareness. We aimed to analyze the effectiveness of prospective audit and feedback (PAF), one of the core strategies in ASP, by applying it to the intensive care units (ICUs). Methods: In this study, we applied PAF to the neurological/surgical ICUs of a tertiary hospital starting from March 1, 2023, we compared the data of 6 months before (from September 2022 to February 2023) and after (from March 2023 to August 2023) the implementation to assess the difference in antimicrobial use density (AUD) and the acquisition rates of antibiotic-resistant bacteria. Furthermore, we surveyed the satisfaction of PAF using a questionnaire. PAF was conducted twice a week during rounds by the ASP team, which consisted of an infectious disease specialist and one assistant. Results: Before and after the implementation of PAF, AUD showed a tendency to decrease in the classes of beta-lactam/beta-lactamase inhibitors, cephalosporins and glycopeptides, although the changes were not statistically significant. The acquisition rate of carbapenem-resistant Acinetobacter baumannii decreased slightly in the surgical ICU. Most participating interns and residents reported that PAF was clinically and educationally helpful in the survey. Conclusion: Implementing PAF twice a week in the neurological/surgical ICUs could reduce antibiotic usage and the acquisition rates of some resistant bacteria.