Table 1.
Assessment sheet used by the AST.
Fig 1.
Trends in the days of carbapenem therapy per 100 patients, by month, during Phase 2 of the intervention period.
Each dot refers to the days of carbapenem therapy per 100 patients in each month, and the slope is based on the linear regression in the two phases. The explanation of each phase is as follows: Phase 1 (antimicrobial notification by the infection control team from April 1, 2018, to March 31, 2020); Phase 2 (establishing an infectious disease [ID] consultation service and implementation of the Antimicrobial Stewardship Program [ASP] from April 1, 2020, to March 31, 2021). The trend in the monthly CAT-DOT decreased (coefficients: −0.14; 95% confidence interval [CI]: −0.22 to −0.06, p = 0.001), and its levels reduced (coefficients: −1.16; 95% CI: −1.74 to −0.55, p<0.001).
Fig 2.
Trends in the days of antipseudomonal agent (piperacillin–tazobactam, cefepime, and cefozopran) therapy per 100 patients, by month, during Phase 2 of the intervention period.
Each dot refers to the days of antipseudomonal agent therapy per 100 patients in each month, and the slope is based on linear regression in the two phases. The explanation of each phase is as follows: Phase 1 (antimicrobial notification by the infection control team from April 1, 2018, to March 31, 2020); Phase 2 (establishing an infectious disease [ID] consultation service and implementation of the Antimicrobial Stewardship Program [ASP] from April 1, 2020, to March 31, 2021). The level of the monthly DOT of the three antipseudomonal agents did not decrease (coefficient: 0.20; 95% confidence interval [CI]: −0.67 to 1.09, p = 0.65), although the trend decreased (coefficient: −2.22; 95% CI: −0.33 to −0.10, p<0.001).
Fig 3.
Trends in the days of narrow-spectrum antibiotic (ampicillin, ampicillin–sulbactam, cefazolin, and cefmetazole) therapy per 100 patients, by month, during Phase 2 of the intervention period.
Each dot refers to the days of narrow-spectrum antibiotic therapy per 100 patients in each month, and the slope is based on linear regression in the two phases. The explanation of each phase is as follows: Phase 1 (antimicrobial notification by the infection control team from April 1, 2018, to March 31, 2020); Phase 2 (establishing an infectious disease [ID] consultation service and implementation of the Antimicrobial Stewardship Program [ASP] from April 1, 2020, to March 31, 2021). The trend in the monthly DOT of the four narrow-spectrum antibiotics increased (coefficient: 0.47; 95% confidence interval [CI]: 0.37 to 0.57, p<0.001), and its level increased (coefficient: 1.76; 95% CI: 1.00 to 2.53, p<0.001).
Fig 4.
Trends in the incidence of multidrug-resistant Pseudomonas aeruginosa (MRPA) per 1000 patients, by month, during Phase 2 of the intervention period.
Each dot refers to the incidence of MRPA per 1000 patients each month and the slope is based on linear regression in the two phases. The explanation of each phase is as follows: Phase 1 (antimicrobial notification by the infection control team from April 1, 2018, to March 31, 2020); Phase 2 (establishing an infectious disease [ID] consultation service and implementation of the Antimicrobial Stewardship Program [ASP] from April 1, 2020, to March 31, 2021). The number of isolated samples in 2018, 2019, and 2020 was 7, 9, and 13, respectively. The level of the monthly incidence of MRPA did not decrease (coefficient: 0.09; 95% confidence interval [CI]: −0.015 to 0.19, p = 0.10), although the trend of the infection was significantly reduced (coefficient: −0.02; 95% CI: −0.02 to −0.004, p = 0.02).
Fig 5.
Trends in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) per 1000 patients, by month, during Phase 2 of the intervention period.
Each dot refers to the incidence of MRSA per 1000 patients each month and the slope is based on linear regression in the two phases. The explanation of each phase is as follows: Phase 1 (antimicrobial notification by the infection control team from April 1, 2018, to March 31, 2020); Phase 2 (establishing an infectious disease [ID] consultation service and implementation of the Antimicrobial Stewardship Program [ASP] from April 1, 2020, to March 31, 2021). The number of isolated samples in 2018, 2019, and 2020 was 61, 72, and 69, respectively. The level of the monthly incidence of MRSA did not decrease (coefficient: 0.12; 95% confidence interval [CI]: −0.16 to 0.42, p = 0.40), although there was a significant reduction in the trend of the infection (coefficient: −0.05; 95% CI: −0.09 to −0.013, p = 0.01).
Table 2.
Purchase costs of carbapenems and all intravenous antimicrobials per patient-days from 2018 to 2020.
Table 3.
Content and acceptance rate of feedback by the AST with regard to specific broad-spectrum antimicrobial usage.