周術期抗菌薬の適正使用に向けた取り組みとアウトカム評価

Toward the optimization of perioperative prophylactic antibacterial agents, the Antimicrobial Stewardship Team (AST) of Nagoya University Hospital began an intervention using the “practical guidelines for proper use of antibacterial agents to prevent postoperative infections” (practical GL). For neurosurgery and ophthalmology, we used a draft of the practical GL. In this study, we investigated the antibacterial agents used in the perioperative period in patients who underwent surgery at our hospital from August 1, 2014, to August 31, 2014 (before AST intervention), August 1, 2016, to August 31, 2016 (one year after the start of the AST intervention), and August 1, 2018, to August 31, 2018 (3 years after the start of the AST intervention). Furthermore, for cases in which the prophylactic antibiotics recommended by the practice GL were used, the compliance rates with the practice GL in respect of the doses of the prophylactic antibiotics, the timing of preoperative administration, the intraoperative readministration interval, and the postoperative duration of administration were investigated. The rates of use of the recommended antibiotics were 60.8% in 2014, 73.8% in 2016, and 89.8% in 2018. The compliance rates in respect of the recommended doses of the prophylactic antibiotics were 61.3% in 2014, 63.0% in 2016, and 91.1% in 2018. The compliance rates in respect of the timing of preoperative administration were 92.1% in 2014, 92.1% in 2016, and 93.1% in 2018. The compliance rates in respect of the intraoperative readministration interval were 82.5% in 2014, 83.0% in 2016, and 85.1% in 2018. The compliance rates in respect of the recommended postoperative durations of administration were 37.4% in 2014, 40.0% in 2016, and 82.9% in 2018. Comparison between 2018 and 2014, revealed an eventual annual drug cost savings of approximately 742 million yen. With the AST intervention, the guideline compliance rates in respect of antibacterial drug selection, dosage, and postoperative duration of administration increased over the years, and the medical economic effect was also obtained.