Fig 1.
Check sheet for the use of anti-MRSA agents (English translation).
Fig 2.
Flow chart of the selection of patients included in this study.
Table 1.
Characteristics of the patients included in this study.
Table 2.
Summary of recommendations by the AST.
Fig 3.
Kaplan–Meier curves showing the effect of PAF implementation on the time to de-escalation of anti-MRSA agents.
The dotted and solid lines indicate the pre-PAF (n = 407) and post-PAF (n = 437) periods, respectively. The time to de-escalation was significantly shorter in the post-PAF period than in the pre-PAF period (median 6 days vs. 7 days, P < 0.001, generalized Wilcoxon test). The inset in the graph presents the same data on an enlarged horizontal axis.
Fig 4.
Subgroup analysis of the effect of PAF implementation on the time to de-escalation of anti-MRSA agents.
The time to de-escalation in two subgroups was estimated using the Kaplan–Meier method. Panels A and B show Kaplan–Meier curves for the “discontinuation” and “oral switch” subgroups, respectively. The “discontinuation” subgroup included 309 and 352 cases from the pre- and post-PAF periods, respectively, and the “oral switch” subgroup included 98 and 85 cases from the pre- and post-PAF periods, respectively. Dotted and solid lines represent Kaplan–Meier curves for the pre- and post-PAF periods, respectively. PAF implementation significantly shortened the time to de-escalation (median 5 days vs. 6 days, P = 0.002, generalized Wilcoxon test) in the “discontinuation” subgroup. In contrast, PAF implementation had no significant effect on the time to de-escalation (median 10 days vs. 12 days, P = 0.082) in the “oral switch” subgroup. The inset in panel A shows the same data on an enlarged horizontal axis.
Table 3.
Results of multivariate analysis of the time to de-escalation.
Table 4.
Effects of PAF implementation on secondary clinical outcomes.
Fig 5.
Effect of PAF implementation on the utilization of anti-MRSA agents.
Time series of monthly DDD (panel A) and DOT (panel B) per 1,000 PD for anti-MRSA agents between April 2014 and March 2016 are plotted against time. Vertical dashed lines in each panel indicate the initiation of daily PAF implementation. Filled circles indicate the individual monthly DDD and DOT. Solid lines indicate the estimated trends during the study period according to interrupted time-series analysis, and the dotted lines indicate the upper and lower limits of the 95% confidence interval. Daily PAF implementation provoked a significant reduction in trends in both DDD (–0.65, 95% CI, –1.20 to –0.11, P = 0.029) and DOT (–0.74, 95% CI, –1.33 to –0.15, P = 0.024) of anti-MRSA agents.