Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the consumption and cost of antimicrobial agents using defined daily dose (DDD) and direct cost of antibiotics before and after the AMS program implementation. Secondary objective was to determine the rate of HAIs [Clostridium difficile (C. difficile), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLABSI) before and after the AMS program implementation. This is a pre-post quasi-experimental study. Adult inpatients were enrolled in a prospective fashion under the active AMS arm and compared with historical inpatients who were admitted to the same units before the AMS implementation. Study was conducted at four tertiary private hospitals located in two cities in Saudi Arabia. Adult inpatients were enrolled under the pre- AMS arm and post- AMS arm if they were on any of the ten selected restricted broad-spectrum antibiotics (imipenem/cilastatin, piperacillin/tazobactam, colistin, tigecycline, cefepime, meropenem, ciprofloxacin, moxifloxacin, teicoplanin and linezolid). A total of 409,403 subjects were recruited, 79,369 in the pre- AMS control and 330,034 in the post- AMS arm. Average DDDs consumption of all targeted broad-spectrum antimicrobials from January 2016 to June 2019 post- AMS launch was lower than the DDDs use of these agents pre- AMS (233 vs 320 DDDs per 1000 patient-days, p = 0.689). Antimicrobial expenditures decreased by 28.45% in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at S.R. 6,286,929 and negligible expenses of S.R. 505,115 (p = 0.648). Rates of healthcare associated infections involving C. difficile, VAP, and CLABSI all decreased significantly after AMS implementation (incidence of HAIs in 2015 compared to 2019: for C. difficile, 94 vs 13, p = 0.024; for VAP, 24 vs 6, p = 0.001; for CLABSI, 17 vs 1, p = 0.000; respectively). Implementation of AMS program at HMG healthcare facilities resulted in reduced antimicrobials use and cost, and lowered incidence of healthcare associated infections.

中文翻译：

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抗生素管理计划在四家三级私立医院实施的影响：五年前岗后分析的结果。

抗菌素管理（AMS）计划已显示出可以减少抗菌素耐药性（AMR）和与卫生保健相关的感染（HAIs）的出现，并节省与不当使用抗菌素相关的卫生保健费用。这项研究的主要目的是比较使用AMS计划实施前后确定的每日剂量（DDD）和抗生素的直接成本来比较抗菌药物的消耗和成本。次要目标是确定在实施AMS计划之前和之后HAI（艰难梭菌（C. difficile），呼吸机相关性肺炎（VAP）和中心线相关性血液感染（CLABSI））的发生率。这是事后准实验研究。将成年住院患者按预期方式纳入活跃的AMS部门，并将其与在实施AMS之前被纳入同一病房的历史住院患者进行比较。研究是在沙特阿拉伯两个城市的四家三级私立医院进行的。如果成人住院患者使用了十种选定的受限广谱抗生素（亚胺培南/西司他丁，哌拉西林/他唑巴坦，大肠菌素，替加环素，头孢吡肟，美洛培南，环丙沙星，莫西沙星，替考拉宁和利奈唑胺）。总共招募了409,403名受试者，AMS前对照组为79,369名，AMS后组为330,034名。在AMS上市后，2016年1月至2019年6月，所有靶向广谱抗菌药物的平均DDD消费量均低于AMS之前这些药物的DDD使用量（每1000病人日233 vs 320 DDD，p = 0.689）。该计划第一年的抗菌药物支出下降了28.45％，在随后的几年中保持相对稳定，总的累计成本节省估计为6,286,929里亚尔，而支出却可以忽略不计505,115 SR（p = 0.648）。实施AMS后，涉及艰难梭菌，VAP和CLABSI的医疗保健相关感染率均显着降低（2015年HAI的发生率与2019年相比：艰难梭菌的发生率分别为94 vs 13，p = 0.024; VAP的发生率分别为24 vs 6， p = 0.001；对于CLABSI，分别为17与1，p = 0.000）。