The impact of antimicrobial stewardship on appropriate use of antimicrobial agents for nosocomial infections caused by gram-negative bacilli in a university hospital in Thailand

Abstract

Antimicrobial stewardship programs (ASP) are crucial for promoting appropriate antimicrobial use and combatting resistance. This prospective cohort study evaluated the impact of ASP on the appropriate use of antimicrobial agents in a university hospital. This study was conducted over a 6-month period, comparing the outcomes of patients managed under the ASP with those in a control group. The primary objective was to assess the appropriate use of antimicrobials. Secondary outcomes included de-escalation rate, duration of therapy, and clinical outcomes (infection-related mortality, clinical and microbiological cure). A total of 311 patients were enrolled in the study, with 181 in the ASP ward and 130 in the control ward. Baseline characteristics were generally comparable between the two groups, except for a lower median age in the ASP group. The appropriateness of antimicrobial use did not significantly differ between the ASP and control groups (67.96% vs. 68.46%, P=0.925). However, the ASP group showed a higher rate of de-escalation (43.09% vs. 23.85%, P<0.01) and a shorter duration of antimicrobial therapy (8 vs. 10 days, P=0.031). Importantly, clinical cure rate was higher in the ASP ward (83.43% vs. 67.69%, P=0.01). There were no significant differences in infection-related mortality and microbiological cure between the two groups. The ASP implementation in a university hospital resulted in increased rates of de-escalation and shorter durations of antimicrobial therapy while the overall appropriate use did not significantly improve. These findings highlight the potential benefits of ASP in optimizing antimicrobial treatment without compromising clinical outcomes.