Method development of an antimicrobial stewardship program in ICU

2023 Fiscal Year Final Research Report

• Project/Area Number: 20K18844
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 58010:Medical management and medical sociology-related
• Research Institution: Tokyo Medical and Dental University
• Principal Investigator: Mishima Yuka 東京医科歯科大学, 生体集中管理学分野, 助教 (90828906)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Keywords: 抗菌薬適正使用 / 集中治療室 / 多職種回診 / Time-out / 抗菌薬使用日数 / 広域抗菌薬

Outline of Final Research Achievements

This study was conducted in the intensive care unit (ICU) without the involvement of a dedicated infectious disease physician. The objective was to evaluate the effectiveness of time-out as an antimicrobial stewardship program (ASP) method. The time-out was conducted at multidisciplinary rounds on three occasions: 3, 7, and 14 days after the initiation of antimicrobial therapy. At each of these occasions, three points were evaluated: the infection sites, the duration of therapy, and the efficacy of the therapy. After the introduction of time out, it was suggested that the length of stay for survival-discharged patients decreased, and the days of therapy of intravenous antimicrobials decreased. Next, in patients who received antimicrobials within 24 hours of admission to the ICU, the association between antimicrobial de-escalation and patient outcome and incidence of new resistant organisms was examined and no difference was found.

Free Research Field

集中治療医学

Academic Significance and Societal Importance of the Research Achievements

本研究はICUにおいて抗菌薬適正使用支援プログラム（ASP）のTime-out手法が有効であることを示し、生存退院患者の入院日数が短縮され、静注抗菌薬の使用日数が減少した。ICUでは広域抗菌薬の使用が多く耐性菌発生リスクが高いが、Time-outにより抗菌薬の適正使用が促進されることが示唆された。また、感染症医が不足する医療現場でもTime-outを用いることで医療資源の効率的な利用が可能となり、医療費削減や耐性菌発生抑制に寄与する可能性がある。抗菌薬のde-escalationにより患者転帰の悪化はないことも示され、ICUにおける感染症対策の改善に貢献する可能性がある。