Accelerating reductions in antimicrobial resistance: Evaluating the effectiveness of an intervention program implemented by an infectious disease consultant

Abstract

Objectives: Very few infectious disease physicians exist in Japan. A concerted infection control intervention program involving an antimicrobial stewardship team and multiple components was designed and implemented in multiple hospitals from 2010. Here, we aimed to retrospectively evaluate the intervention program’s effectiveness. Methods: The frequencies of methicillin resistant Staphylococcus aureus (MRSA) and drug-resistant Pseudomonas aeruginosa were monitored in four acute-care hospitals. The primary goal of the program was to accelerate the speed of decline of such resistance. A quasi-experimental study design was used to detect accelerated rates of increases in drug susceptibility, comparing time before and after the intervention. Results: Both MRSA and drug-resistant P. aeruginosa exhibited decreasing trends (p < 0.01 for all four hospitals and all bacterial cultures). Compared with the whole of Japan, the decreasing trends for MRSA and drug-resistant P. aeruginosa in the four hospitals accelerated after the intervention program was established; notably, the rate of MRSA decrease increased by 50%–150% of its original value. Conclusions: The intervention program successfully reduced the proportion of drug resistance in the four hospitals. Centering on systematic education, decision-making support, and implementation and oversight by an infectious disease consultant, this program was shown to be effective where specialist physicians are scarce. Keywords: Nosocomial infection, Drug utilization, Drug resistance, Infection control practitioners, Training programs