An antibiotic stewardship program in general surgery improve antibiotics use and cost savings

Author(s):
Salvatore Paiella; Erica Secchettin

Background:

Antimicrobial resistance is a worldwide and growing public healthcare problem. In addition to its clinical implications, antimicrobial resistance imposes an economic burden. The WHO tackles the matter on two sides: preventing the spread of resistant micro-organisms by infective control programs and by reducing inadequate prescription and use of antibiotics. Antimicrobial stewardship programs (ASP) have been found to be effective on both sides. Using an interrupted time series analysis, the ability of a prospective ASP in pancreatic surgery to evaluate the changes in antibiotics consumption and cost savings before and after the program implementation was assessed.

Hypothesis:

An ASP program in general surgery leads to better antibiotic use and cost savings.

Methods:

The analysis used data from a single center involved in a multicenter ASP, the Pancreatic Surgery Unit of the University of Verona. They were obtained during the study period going from 2015 to 2022. Two time periods were designated for comparison, pre-ASP (years 2015-2018) and post-ASP implementation (years 2019-2022). An interrupter time series analysis was applied considering the post-ASP, 32-month period. Drug consumption of systemic antibiotics (presented as anatomical therapeutic chemical – ATC-J01/defined daily doses – DDD – and normalized per 1000 patients-days (PDs), the trend of “Access” and “Watch” (defined according to WHO definitions) antibiotics use, and cost savings were evaluated. Outcomes were measured by comparing the two phases.

Results:

The ASP was associated with a statistically significatnt reduction in the use of “Watch” antibiotics (-2.89, 95%CI [-5.55 – – 0.23], p= 0.0341, Figure 1), followed by non-statistically significant increased use of “Access” antibiotics (3.48, 95%CI [- 4.93 – 11.89], p= 0.404), measured in DDD/1000 PDs. The ASP also produced an overall monthly cost reduction despite not being statistically significant (-241.62€; p= 0.523). The total cost savings was 24746,40€. The “Watch” antibiotics cost was reduced by 22292,03€, whereas the “Access” ones increased by 5291,60€.

Conclusions:

An ASP in general surgery produces important changes in antibiotic use. As promoted by the WHO, thanks to more appropriate antibiotic prescribing and administration, the use of “Watch” antibiotics was reduced. Besides the clinical benefits in surgical site infection reduction, ASP may also have positive pharmacoeconomic effects.