Antibiotic usage at a private hospital in Central Java: results of implementing the Indonesian Regulation on the Prospective Antimicrobial System (Regulasi Antimikroba Sistem Prospektif Indonesia [RASPRO])
Methods: A pre–post-descriptive study was conducted in 2019 for 3 months at a private hospital in Central Java, Indonesia, to evaluate the implementation of the Regulation on Indonesian Antimicrobial Stewardship Program (ASP), namely, the Prospective Antimicrobial System/Regulasi Antimikroba Sistem Prospektif Indonesia (RASPRO). Outcomes were measured before and after the implementation of the RASPRO in the ward including: 1) intravenous antibiotic defined daily dose (DDD) per 100 patient-days, 2) antibiotic expenditure, and 3) antibiotic expenditure per inpatient.
Result: The total antibiotic consumption was expressed in DDD/100 patient-days. For the levofloxacin category, the number increased intensely from 2.38 to 15.29; carbapenem escalated from 0.51 to 2.31, ceftriaxone from 32.10 to 38.03, and ampicillin sulbactam from 1.14 to 1.18. In contrast, cefuroxime significantly reduced from 17.25 to 1.38, cefotaxime decreased from 10.33 to 6.83, gentamicin decreased from 3.18 to 1.91, and amikacin decreased from 2.27 to 2.13. The overall cephalosporin usage decreased from 19.89 to 15.41. The total antibiotic expenditure had a decline of 20.28%, followed by 14.44% reduction on the percentage of antibiotic expenditure per inpatient.
Conclusion: Our study describes the 3-month analysis of antimicrobial usage before and after the implementation of the RASPRO by evaluating several parameters. The antibiotic consumption expressed in DDD/100 patient-days for each antibiotic category has demonstrated that there are different impacts that may be debatable and calls for further evaluation. A decrease in the total antibiotic expenditure has also been reported. However, since our study is a preliminary study, it should be continued by further studies that involve longer study duration to observe further impacts of the program.
Ben-Ami R, Rodrigues-Bano J, Arslan H, Pitout JDD, Quentin C, Calbo ES, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in nonhospitalized patients. Clin Infect Dis 2009; 49(5): 682–90. doi: 10.1086/604713
Drynka P, Niederman MS, El-Solh AA, Crnich CJ. Assessment of risk factors for multi-drug resistant organisms to guide empiric antibiotic selection in long term care: a dilemma. J Am Med Dir Assoc 2010; 12(5): 321–5. doi: 10.1016/j.jamda.06.012
Falagas ME, Koletsi PK, Bliziotis IA. The diversity of definitions of multidrug-resistant (MDR) and pan drug-resistant (PDR) Acinetobacter baumannii and Pseudomonas aeruginosa. J Med Microbiol 2006; 55: 1619–29. doi: 10.1099/jmm.0.46747-0
Huys G, Cnockaert M, Vaneechoutte M, Woodford N, Nemec A, Dijkshoorn L, et al. Distribution of tetracycline resistance genes in genotypically related and unrelated multiresistant Acinetobacter baumannii strains from different European hospitals. Res Microbiol 2005; 156: 348–55. doi: 10.1016/j.resmic.2004.10.008
Parathon H, Kuntaman K, Widiastoety TH, Muliawan BT. Progress towards antimicrobial resistance containment and control in Indonesia. Br Med J 2017; 358: j3808. doi: 10.1136/bmj.j3808
Hadi U, Kuntaman, QiptiyahM , ParatonH . Problem of antibiotic use and antimicrobial resistance in Indonesia: are we making a progress? Ind J Trop Med Inf Dis 2013; 4(4): 5–8. doi: 10.20473/ijtid.v4i4.222
Kolar M, Urbanek K, Latal T. Antibiotic selective pressure and development of bacterial resistance. Int J Antimicrob Agents 2011; 17: 357–63. doi: 10.1016/S0924-8579(01)00317-X
European Centre for Disease Prevention and Control. Summary of the Latest Data on Antibiotic Consumption in the European Union ESAC-Net Surveillance Data. November 2017. Available from: https://www.ecdc.europa.eu/sites/portal/files/documents/Final_2017_EAAD_ESAC-Net_Summary-edited%20-%20FINALwith%20erratum.pdf [cited 1 May 2020].
Falcone M, Russo A, Giannella M, Cangemi R, Scarpellini MG, Bertazzoni G, et al. Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia. PLoS One 2015; 10(4): e0119528. doi: 10.1371/journal.pone.0119528
Aliberti S, Di Pasquale M, Zanaboni AM, Cosentini R, Brambilla AM, Seghezzi S, et al. Stratifying risk factors for multi-drug resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Inf Dis 2012; 54(4): 470–8. doi: 10.1093/cid/cir840
Gomila A, Shaw E, Carratala J, Leibovici L, Tebe C, Wiegand I, et al. Predictive factors for multidrug-resistant gram-negative bacteria among hospitalized patients with complicated urinary tract infections. Antimicrob Resist Infect Control 2018; 7: 111. doi: 10.1186/s13756-018-0401-6
Johnson SW, Anderson DJ, May DB, Drew RH. Utility of a clinical risk factor scoring model in predicting infection with extended-spectrum β-lactamase-producing Enterobacteriaceae on hospital admission. Infect Control Hosp Epidemiol 2013; 34(4): 385–92. doi: 10.1086/669858
Slavcovici A, Streinu-Cercel A, Tatulescu D, Radulescu A, Mera S, Marcu C, et al. The role of risk factors (‘Carmeli Score’) and infective endocarditis classification in the assessment of appropriate empirical therapy. Ther Pharmacol Clin Toxicol 2009; 8(13): 1: 52–6.
Zaha DC, Kiss R, Hegedus C, Gesztelyi R, Bombicz M, Muresan M, et al. Recent advances in investigation, prevention, and management of healthcare-associated infections (HAIs): resistant multidrug strain colonization and its risk factors in an intensive care unit of a university hospital. Hindawi BioMed Res Int 2019; 2019: 2510875, 9 pages. doi: 10.1155/2019/2510875
Pagani L, Colinon C, Migliavacca R, Labonia M, Docquier JD, Nucleo E, et al. Nosocomial outbreak caused by multidrug-resistant Pseudomonas aeruginosa producing IMP-13 metallo-beta-lactamase. J Clin Microbiol 2005; 43(8): 3824–8. doi: 10.1128/JCM.43.8.3824–3828.2005
Tam VH, Chang KT, Abdelraouf K, Brioso CG, Ameka M, McCaskey LA, et al. Prevalence, resistance mechanisms, and susceptibility of multidrug-resistant bloodstream isolates of Pseudomonas aeruginosa. Antimicrob Agent Chemother 2010; 54(3): 1160–4. doi: 10.1128/aac.01446-09
Natadidjaja RI, Fitra Y, Saroyo YB, Matatula A, Sundariningrum RW. Decreasing the broad spectrum antibiotics unit sold: the prospective antimicrobial stewardship of RASPRO. J Antimicrobial Resist Inf Contr 2019; 8(suppl 1): P357.
Lai CC, Shi ZY, Chen YH, Wang FD. Effect of antimicrobial stewardship programs on antimicrobial usage and resistance among common gram-negative bacilli causing health care-associated infections: a multicenter comparison. J Microbiol Immunol Infect 2016; 49(1): 74–82. doi: 10.1016/j.jmii.2015.05.011
McGowan JE. Antimicrobial stewardship: the state of the art in 2011 – focus on outcome and methods. Infect Control Hosp Epidemiol 2012; 33(4): 331–7. doi: 10.1086/664755
MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005; 18(4): 638–56. doi: 10.1128/CMR.18.4.638-656.2005
Copyright (c) 2021 Ronald Irwanto Natadidjaja, Tarcisius Henry, Hadianti Adlani, Aziza Ariyani, Rika Bur
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to IJIC. Read the full Copyright- and Licensing Statement.