The Need for Antibiotic Stewardship Program in a Hospital Using a Computerized Preauthorization System

Abstract Objectives Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are preauthorization, prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) is in use since 2003. We aimed to measure the effect of a prospective audit and feedback strategy system along with NARP. Methods We designed a prospective quasi-experimental study between March and June of 2017. To approve the antibiotics a computerized preauthorization system was used as an ASP strategy. During baseline period patients with intravenous (IV) antibiotic use ≥72 hours were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physician with an IV antibiotic use ≥72 hours. The modified Kunin et al. and Gyssens et al. criteria were followed for appropriateness of prescribing. Days of therapy (DOT) and lenght of stay (LOS) were calculated compared between two study periods. Results Among 519 patients, 866 antibiotic episodes were observed. A significant systemic antibiotic consumption reduction was observed in the intervention period (575 vs 349 DOT per 1000 patient days; p  0.001). In multivariate analysis prospective audit and feedback (OR, 1.5; 95% CI, 1.09-2.04; p  = 0.011) and preauthorization of restricted antibiotics (OR, 1.7; 95% CI, 1.2-2.31; p  = 0.002) were the predictors for appropriate antimicrobial use. Mean LOS was decreased 2.9 days ( p = 0 .095). Conclusion This study shows that the antimicrobial restriction program alone is effective, but the system should be supported by a tailored ASP such as prospective audit and feedback .