Antimicrobial stewardship of Chinese ministry of health reduces multidrug-resistant organism isolates in critically ill patients: a pre-post study from a single center

Xudong Ma, Jianfeng Xie, Yi Yang, Fengmei Guo, Zhiwei Gao, Hua Shao, Yingzi Huang, Congshan Yang, Haibo Qiu, Xudong Ma, Jianfeng Xie, Yi Yang, Fengmei Guo, Zhiwei Gao, Hua Shao, Yingzi Huang, Congshan Yang, Haibo Qiu

Abstract

Background: China's Ministry of Health (MOH) has established a policy about the antimicrobial stewardship. To date, the effects of this policy on multidrug-resistant organism (MDRO) in critically ill patients are unknown.

Methods: A pre-post study was conducted on intensive care unit (ICU) patients from June 2010 to May 2011 and from June 2012 to May 2013. Bacterial cultures were conducted at ICU admission and discharge. In June 2011, our hospital started to administer the antimicrobial stewardship program of Chinese MOH. We collected the data on antimicrobial consumption during the 3-year period in all hospital and individual department every month, and analyzed the correlation between the proportion of critically patients colonized or infected with MDRO and antimicrobial consumption.

Results: A total of 978 patients were involved in the present study. With the intervention, the monthly mean Defined Daily Dose (DDD) per 100 occupied bed-days throughout the hospital decreased from 96 ± 7 to 65 ± 6 (p < 0.001), and the proportion of patients colonized or infected with MDRO decreased from 36 to 13% at the time of ICU admission and declined from 48 to 29% at the time of ICU discharge (both p < 0.001). There was a significant positive relationship between the proportion of all critically ill patients colonized or infected with MDRO at ICU admission and the DDD of the entire hospital (R2 = 0.7858, p < 0.001).

Conclusion: The antimicrobial stewardship program of Chinese MOH reduced the consumption of antibiotics. Moreover, the proportion of patients colonized or infected with MDRO decreased along with reduced consumption of antibiotics.

Trial registration: Retrospectively registered: NCT02128399; Date of registration: 22 APR 2014; Detail information web link: https://ichgcp.net/clinical-trials-registry/NCT02128399?term=NCT02128399&rank=1.

Keywords: Antimicrobial consumption; Antimicrobial stewardship; Defined daily dose; Multidrug-resistant organism.

Figures

Fig. 1
Fig. 1
Antibiotic consumption of our hospital and ICU decreased after the management of antibacterial drugs in clinical applications
Fig. 2
Fig. 2
Proportion of patient colonization of infection with MDRO at the time of ICU admission and discharge decreased after antimicrobial clinical application management
Fig. 3
Fig. 3
A significant positive relationship between the proportion of critically ill patient colonization or infection with MDRO at the time of ICU admission monthly and total antimicrobial consumption in our hospital monthly (R2 = 0.7858, p < 0.001)
Fig. 4
Fig. 4
a There was no relationship between the DDD in the ICU and the MDRO rate at the time of ICU discharge (R2 = 0.1085, p = 0.116); b there was significant relationship between increased percentage of MDRO rate from the time of ICU admission to discharge from the ICU and DDD in the ICU (R2 = 0.2056, p = 0.038)
Fig. 5
Fig. 5
a There was no significant relationship between carbapenem consumption throughout the hospital and resistance of A. baumannii to carbapenem at the time of ICU admission (R2 = 0.0436, p = 0.393). b There was no significant relationship between carbapenem consumption in the ICU and resistance of A. baumannii to carbapenem at the time of ICU discharge (R2 = 0.0798, p = 0.181)

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