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A permission system for carbapenem use reduced incidence of drug-resistant
bacteria and cost of antimicrobials at a general hospital in Japan
#MMPMID22515115
Ikeda Y
; Mamiya T
; Nishiyama H
; Narusawa S
; Koseki T
; Mouri A
; Nabeshima T
Nagoya J Med Sci
2012[Feb]; 74
(1-2
): 93-104
PMID22515115
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Some drug management systems have been established in Japanese hospitals to
reduce medical costs and regulate drug usage. Among the many available
prescription drugs, antimicrobials should be given special attention because
their inappropriate use often leads to sudden outbreaks of resistant bacteria. As
drug specialists, pharmacists should monitor the use of all drugs, particularly
antimicrobials. Carbapenems are a class of broad-spectrum antimicrobials that are
widely used to treat infections worldwide. However, their inappropriate use has
led to an increase in the incidence of drug-resistant bacteria and consequently,
medical costs, at hospitals. To reduce inappropriate use and drug resistance, we
have established a permission system to control the use of carbapenems at the
Japanese Red Cross Nagoya Daiichi Hospital. In this study, we retrospectively
evaluated the applicability of the new permission system compared to that of the
notification system and the non control system for 14 months each. The two
management systems were able to maintain total antibiotic use density and control
the outbreak of drug-resistant bacteria (P. aeruginosa, E. coli, and K.
pneumoniae). The number of carbapenem prescriptions was decreased dramatically
when this permission system was enforced. Compared to the non control system, the
cost of antimicrobials was reduced by $757,470 for the 14-month study period
using the permission system. These results suggest that our system to control the
use of antimicrobials can efficiently suppress the incidence of drug-resistant
bacteria and medical costs at hospitals.
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