Sustainable implementation of antibiotic stewardship on a surgical intensive care unit evaluated over a 10-year period

Objective This retrospective observational study examined the implementation of antibiotic stewardship (ABS) on the surgical intensive care unit (SICU) of a specialized academic teaching hospital. Methods Application density of antimicrobial agents (ADA), substance class change, development of resistance, and clinical outcomes were investigated with reference to ABS in three intervals over a 10-year period: the pre-intervention phase (2008-2010), the intervention phase (2011-2014), and the post-intervention phase (2015-2017). Results Following the introduction of ABS, ADA was reduced from 89.3 recommended daily doses/100 patient days (RDD/100 PD) at the pre-intervention phase to 68.0 RDD/100 PD at the post-intervention phase. The antibiotic ADA (AB-ADA) similarly showed a significant decrease from 83.3 to 62.0 RDD/100 PD (p < 0.0001). The case mix index (CMI), which describes the average case severity across patients and mortality on the SICU was not significantly different comparing intervention and post-intervention phase. It was also possible to achieve a substance class change following the introduction of ABS. There was no obvious change in bacterial resistance rates. Conclusion The study demonstrates a sustainable effect of the implementation of ABS, which was sustained through the post-intervention phase.