Kolk, C. van der (2012) Effect van een Antimicrobial Stewardship Program op het antibioticagebruik in het Deventer Ziekenhuis’. thesis, Medicine.
Full text available on request.Abstract
Background: In the last few years there’s an increase in antimicrobial resistance, which is mainly due to unnecessary and incorrect use of antibiotics. The use of antibiotics in a hospital can be improved by an antimicrobial stewardship program (ASP). The primary goals of ASPs are to prevent or delay the emergence of antimicrobial resistance, optimize the selection, dosing and duration of antimicrobial therapy in individual patients, reduce adverse drug events and reduce morbidity, mortality, length of hospitalization and health-care related costs. Numerous previous studies showed that ASPs are an effective instrument to improve the correct use of antibiotics and the decrease of antimicrobial resistance. Local guidelines for antimicrobial use in the Deventer Hospital (DZ) are based on the national guideline of the Dutch Working Party on Antibiotic Policy (SWAB). Objectives: This study comprised two main elements. Firstly, it was investigated whether an ASP could improve the correct use of antibiotics in the DZ. Secondly, the volume of utilization of antibiotics and the prevalence of antimicrobial resistance in the DZ was compared to other hospitals in The Netherlands. Methods: A twelve week prospective cohort survey was conducted from 14-04-2012 until 20-07-2012. All patients in the DZ who were treated with antibiotics were included in this study. For every antibiotic course it was investigated whether it was prescribed according to local guidelines. After 6 weeks of inclusion every member of medical staff was informed about the study and attention was asked for the local antimicrobial guidelines. After this, another 6 weeks of patient inclusion followed. The difference in correct use of antibiotics before and after the intervention was compared. Additionally, the use of antibiotics in the DZ was compared to that of other hospitals in The Netherlands by investigating results of the Prevention of Hospital Infections by Surveillance (PREZIES) study. Data on antimicrobial resistance in the DZ were compared to antimicrobial resistance in other hospitals in The Netherlands by means of the Infectious Disease Surveillance Information System – Antimicrobial Resistance (ISIS-AR) database. Results: After the intervention the use of antibiotics following the local guidelines was not improved significantly (from 67,8% to 71,9% p-value 0,257). The correct use of antibiotics was not improved either (from 72,9% to 77,0% p-value 0,181). The correct switch from intravenous to oral therapy improved after intervention significantly (from 60,7% to 80,8%, p-value 0,000). The PREZIESstudy showed that in the DZ more cephalosporines were used and less amoxicillin/clavulanate than other hospitals in the Netherlands. The antimicrobial resistance in Deventer Hospital corresponded with the antimicrobial resistance in other hospitals in the Netherlands. Conclusion: The ASP in this study does not improve the use of antibiotics following the SWAB guideline and the correct use of antibiotics. The switch from intravenous to oral therapy improved after a intervention. In the future, a more extensive and longer ASP is expected to give better results. In the DZ there are more cephalosporines and less amoxicillin/clavulanate used than other hospitals in the Netherlands. The antimicrobial resistance in the DZ is comparable with the antimicrobial resistance in other hospitals in the Netherlands. In the future it seems to be important to use an ASP to improve correct use of antibiotics and decrease antimicrobial resistance.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Begeleider: and Zwet, dr. W.C. van der arts-microbioloog and Locatie: Medische Microbiologie, Deventer Ziekenhuis |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:50 |
| Last Modified: | 25 Jun 2020 10:50 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1077 |
Actions (login required)
 |
View Item |