Impact of the introduction of the national antimicrobial stewardship standard across Queensland Health hospitals: ecological observational study exploring patterns of antimicrobial use.

Autor: Holland C; Metro North Public Health Unit (MNPHU), Metro North Hospital and Health Service, Brisbane, Australia. Electronic address: Candice.Holland@health.qld.gov.au., Ballard E; Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia., Griffin A; Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia., Coulter S; Pathology Queensland, Queensland Public Health and Scientific Services, Brisbane, Australia., Yarwood T; Queensland Statewide Antimicrobial Stewardship Program (QSAMSP), Metro North Hospital and Health Service, Brisbane, Australia., Heney C; Pathology Queensland, Queensland Public Health and Scientific Services, Brisbane, Australia., Young M; Metro North Public Health Unit (MNPHU), Metro North Hospital and Health Service, Brisbane, Australia; School of Public Health, University of Queensland, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.
Jazyk: angličtina
Zdroj: The Journal of hospital infection [J Hosp Infect] 2024 Sep; Vol. 151, pp. 60-68. Date of Electronic Publication: 2024 Jun 14.
DOI: 10.1016/j.jhin.2024.05.018
Abstrakt: Background: Antimicrobial stewardship programmes are a critical tool for addressing the rising threat of antimicrobial resistance.
Aim: To determine changes in patterns of antimicrobial use in Queensland public hospitals following introduction of the National Safety and Quality Health Service antimicrobial stewardship standard.
Methods: A retrospective pre/post intervention study was conducted across Queensland public hospitals at the ecological level using Queensland Health's MedTRx database. An interrupted time-series analysis was performed using linear regression models to determine rates of antimicrobial use by quarterly aggregated defined daily dose per 1000 patient-days, for groups of hospitals stratified by peer group classification. Pre-defined time-periods for antimicrobial stewardship programme implementation in response to the introduction of the standard were analysed.
Findings: In the post-intervention period, there was a decrease in overall use of systemic antimicrobials, glycopeptides, carbapenems and fluoroquinolones in principal referral and public acute group A hospitals. A decrease in overall use was also observed for smaller regional and remote public acute group C and D hospitals; however, increases in glycopeptide and fluoroquinolone use were observed. Third-generation cephalosporin use was unchanged for all hospital peer groups. The proportion of overall use that was accounted for by narrow-spectrum penicillin was low for all facilities, with modest improvements in the post-intervention period observed in principal referral facilities only.
Conclusion: These findings add to current knowledge on the effectiveness of legislative quality standards on antimicrobial stewardship at the macro level and highlight gaps to target for future programmes.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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