Comparing the effects of antimicrobial stewardship at primary emergency centers

Background: Antimicrobial prescription rates tend to be high in outpatient settings and Primary Emergency Medical Centers (PECs) in Japan encounter difficulties in implementing antimicrobial stewardship programs (ASPs). While a nudge-based ASP publishing monthly newsletters reduces inappropriate prescription of oral third-generation cephalosporins (3GCs), which requires considerable effort. Therefore, developing more preferable ASP models in PECs is essential. Methods: We conducted a three-center, retrospective observational study. Himeji City Emergency Medical Center (Site A) introduced a facility-specific guideline for antimicrobial stewardship with reference to national guidelines. The Kobe Children ' s Primary Emergency Medical Center (Site B) provided the results of monitoring antibiotics prescription in a monthly newsletter. The Hanshin-Kita Children ' s First-Aid Center (Site C) did not perform a specific ASP. Prescription rates for 3GCs were categorized into pre-and post-intervention and compared using Poisson regression analysis. The difference-in- difference method was used to assess the effect of these interventions. Results: The numbers of patients pre-and post-intervention were 177,126 and 91,251, respectively. The 3GCs prescription rate at Site A, Site B, and Site C decreased from 6.7%, 4.2%, and 6.1% in 2016 to 2.3%, 1.0%, and 2.0% in 2019, respectively. Site B had a greater reduction than Site A and Site C (relative risk [RR] 0.71 [95% confidence interval (CI): 0.62-0.82]; p < 0.001, RR 0.71, [95% CI: 0.62-0.81]; p < 0.001). There was no significant difference between Site A and Site C ( RR 1.00 [95% CI 0.88-1.13]; p = 0.963). Conclusion: A facility-specific guideline was less effective than a nudge-based ASP for decreasing oral 3GC prescriptions in PECs.

Automated summary

The study found that a facility-specific guideline was less effective than a nudge-based antimicrobial stewardship program in reducing oral third-generation cephalosporin prescriptions in Primary Emergency Medical Centers (PECs).