Evaluation And Implementation Of Antimicrobial Stewardship Checklist In A Respiratory Intensive Care Unit In A Tertiary Teaching Hospital

Background:The phenomenon of the antimicrobial drugs misuse and abuse in intensive care units（ICU）is prevailing and widespreading,which created a high selective pressure to microorganisms and facilitate the prevalence of multi-drug resistant organism（MDRO）of clinical importance.The consumption of antimicrobial drugs and other medical resources has received great attention from the antimicrobial research community and administrative department.Antimicrobial stewardship（AMS）has been incorporated into the policies of governments or hospitals all around the world.Research showed that the proper formulation and utilization of antimicrobial stewardship checklist is an applicable and important strategy for antimicrobials management in critical care medicine and which has not received due attention in clinical practice.Objective:To investigate and analyze retrospectively the consumption of antimicrobial drugs and clinical outcomes in the respiratory intensive care unit（RICU）before and after antimicrobial stewardship checklist implementation,to explore its value in guiding clinical antimicrobial drug application and management.Methods:We designed a precision and applicable antimicrobial stewardship checklist according to RICU working practice.All the antimicrobials related data with a duration of time from January 2013 to December 2019 of the RICU inpatients of the First Affiliated Hospital of Bengbu Medical College was analyzed retrospectively according to the methods of historical control study.All inpatients from January 2013 to December2015,before the implementation of antimicrobial stewardship checklist,was set as control group;and that after the implementation from January 2017 to December 2019was set as intervention group.Data as the frequency of antimicrobial drug use（DDDs）,intensity of antimicrobial drug use（AUD）,pathogenic test results,hospitalization mortality rate,length of RICU stay and hospital costs of the two groups were collected,calculated and analyzed with Microsoft Excel software and IBM SPSS Statistics26.0.Quantitative data according with normal distribution are expressed by mean±standard deviation,t-test using independent samples;quantitative data not according to normal distribution are expressed by M（P25,P75）,Mann-Whitney U test between groups;categorical data were described using the composition ratio and comparisons between groups were made using theχ~2test with a statistically significant difference determined at P<0.05.Results:1.Totally,329 patients were included in the control group and 550 patients in the intervention group,and there was no significant difference in age or gender among the study patients.No differences in disease composition and demographic information,such as age and gender,were found in the two groups.2.the AUD values were 207.51（DDD/100 person/day）and 146.21（DDD/100person/day）in the control（n=329）and intervention（n=550）groups respectively.a dramatic decrease found in AUD after the clinical implementation of antimicrobial stewardship checklist.3.The antimicrobial use rate of inpatients reduced significantly from 99.70%of control group to 87.27%of intervention group（P<0.001）;the use rate of special grade antimicrobial reduced significantly from 67.99%of control group to 25.83%of intervention group（P<0.001）,the antimicrobial co-medication rates decrease from94.82%to 65.21%（P<0.001）with significant differences.4.The microorganism sampling rate before antimicrobial use was 92.68%and97.50%in the control and intervention groups respectively（P=0.001）,among which the microorganism sampling rate before receiving special grade antimicrobial was94.14%and 100%（P<0.001）,all with significant differences.5.The length of RICU stay was 8（6,13）and 8（5,12）days in the control and intervention groups,and the duration of antimicrobial medication was reduced from 8（6,13）to 7（4,10）days（P<0.05）with significant difference between the two groups.6.The inpatient mortality rate decreased from 6.99%to 4.91%before and after the intervention of antimicrobial stewardship checklist in both groups,but the difference was not statistically significant（χ~2=1.149,P=0.284）.Conclusion:The implementation of antimicrobial stewardship checklist can be help in reduce the intensity of antimicrobial drug usage,reduce the percentage of combined use and high-grade use of antimicrobials,which is helpful to rationalize antimicrobial use and has high value of clinical application and further promotion.