Evaluation of the Short-Term Effects of Antimicrobial Stewardship in the Intensive Care Unit at a Tertiary Hospital in China

Antibiotic abuse can lead to antibiotic resistance, which is a severe problem in China. The purpose of this study is to evaluate the short-term effects of antimicrobial stewardship strategies, including formulary restriction, preauthorization, perioperative quinolone restriction, and control of total antibiotic consumption in the ICU at a tertiary hospital in China. After implementation of antimicrobial stewardship, the total antibiotic consumption in the ICU significantly decreased. The defined daily doses (DDDs) per 100 patient-days decreased from 197.65 to 143.41; however, the consumption of cephalosporins increased from 53.65 to 63.17 DDDs. Significant improvements in resistance to amikacin, gentamicin, ciprofloxacin, ofloxacin, ceftriaxone, ceftazidime, and piperacillin in Enterobacteriaceae and resistance to ceftazidime, imipenem, and meropenem in non-fermenting Gram-negative rods were observed. In addition, the initial use of no antibiotics or of a single antibiotic significantly increased (P

抗生素滥用可引发抗生素耐药性，该问题在中国形势严峻。本研究旨在评估抗菌药物管理（Antimicrobial Stewardship）策略的短期效果，此类策略涵盖处方目录限制、预先授权、围手术期喹诺酮类药物限制，以及中国某三级医院重症监护室（Intensive Care Unit, ICU）内的抗生素总消耗量管控。实施抗菌药物管理策略后，该ICU的抗生素总消耗量显著下降。每100患者日的限定日剂量（Defined Daily Doses, DDDs）从197.65降至143.41；然而头孢菌素类药物的消耗量却从53.65升至63.17 DDDs。研究观察到，肠杆菌科（Enterobacteriaceae）对阿米卡星、庆大霉素、环丙沙星、氧氟沙星、头孢曲松、头孢他啶及哌拉西林的耐药性得到显著改善；非发酵革兰阴性杆菌（non-fermenting Gram-negative rods）对头孢他啶、亚胺培南和美罗培南的耐药性亦有明显提升。此外，初始未使用抗生素或仅使用单一抗生素的用药方案显著增多（P