Improvement of Antimicrobial Drug Administration Using an Anti-biogram and Critical Path
Yoshihiko MATSUKI1)2), Koji ISHIGE1)2), Masanari ISHIDA2), Erina ATOJI1)3), Takemi KAZAMA1)4), Tetsuya TANIHIRA5), Kazunori ARAKI1)6), Tamaki WATANABE7) and Shigekazu WATANABE7)
1)Infection Control Committee, Kashiwa Kousei General Hospital, Ageo Medical Group, 2)Department of Pharmacy, Kashiwa Kousei General Hospital, Ageo Medical Group, 3)Department of Nursing, Kashiwa Kousei General Hospital, Ageo Medical Group, 4)Department of Clinical Laboratory, Kashiwa Kousei General Hospital, Ageo Medical Group, 5)Department of Internal Medicine, Kashiwa Kousei General Hospital, Ageo Medical Group, 6)Department of Pediatrics, Kashiwa Kousei General Hospital, Ageo Medical Group, 7)Practical Pharmacy of Pharmaceutical Sciences, Teikyo University
The appearance of multidrug-resistant bacteria markedly increases the medico-economic burden, such as by causing severe infection and prolonging the admission period. We proposed highly effective antimicrobial drugs to physicians using an anti-biogram to decrease the use of antimicrobial drugs with anti-Pseudomonas activity. Furthermore, we investigated pneumonia, which requires a long admission period, and standardized treatment using a critical path (CP). The introduction of CP reduced the number of prescriptions for carbapenem preparations, which had been used for patients in whom sufficient therapeutic effects were not obtained due to the inadequate use of antimicrobial drugs or those in whom causative bacteria could not be identified. As a result, the percent antimicrobial use density and percent days of therapy using carbapenem preparations with antimicrobial drugs having anti-Pseudomonas activity before the start of CP were 43.7 and 34.1%, respectively. After the start of CP, the values were 23.6 and 25.8%, respectively, showing decreases. Concerning the antimicrobial drug sensitivity (%) of Pseudomonas aeruginosa, the cefepime sensitivity before and after the start of activities was 71.3 and 93.6%, respectively. The meropenem sensitivity was 64.4 and 92.9%, respectively. The doripenem sensitivity was 65.0 and 94.7%, respectively. The ciprofloxacin sensitivity was 68.8 and 92.9%, respectively; significant improvements were achieved (P<0.01). Our activities may have decreased the use of broad-spectrum antimicrobial drugs without reducing the quality of medical practice, while maintaining the antimicrobial drug sensitivity of P. aeruginosa.
Key words：anti-biogram, clinical path, antimicrobial use density, days of therapy, Pseudomonas aeruginosa
Received: April 10, 2018
Accepted: September 26, 2018