Other specific DSP article suggested by Editorial Board
Impact of a Pharmacist-Led Grid-Based Stewardship Program on the Association Between Antimicrobial Use and Resistance: A 7.5-Year Interrupted Time-Series Analysis in a Chinese Tertiary Hospital.
DOI: 10.2147/IDR.S603756
Authors: Mei Z, et al
Abstract
Background: Whether antimicrobial stewardship programs (ASPs) modulate the association between antimicrobial use and resistance remains uncertain. Long-term evidence for precision stewardship models in Chinese tertiary hospitals is scarce.
Methods: A 7.5-year interrupted time-series analysis (2018-2025) was conducted at a 1900-bed Chinese tertiary hospital. A pharmacist-led, grid-based precision ASP-stratifying 29 departments via Boston Matrix and integrating four synergistic pillars-was implemented in July 2020. Segmented regression models, adjusted for seasonality and autocorrelation, evaluated changes in antimicrobial use density (AUD), clinical/economic outcomes, and the temporal association (R 2) between AUD and multidrug-resistant organism (MDRO) detection rates.
Results: The ASP was associated with an immediate AUD reduction (-25.6%, β 2 = -14.55 DDDs/100 patient-days, P < 0.001) and a sustained decline in antimicrobial use rate (β 3 = -0.003, P < 0.001). Key antimicrobial classes showed marked reductions (fluoroquinolones: -40.2%; carbapenems: -16.1%). The ASP was also associated with improved clinical outcomes, including shorter median length of stay (10.9 to 8.8 days), 52% lower all-cause mortality (0.79% to 0.38%, P < 0.001), and declining per capita antimicrobial costs (β 3 = -19.39 CNY/month, P < 0.001). Notably, the AUD-MDRO temporal association varied across pathogens: R 2 for MRSA, CREco, and CRAB decreased by 71.8% to 87.0%, moderately weakened for CRKP (49.8%), but paradoxically strengthened for CRPA (+78.3%).
Conclusion: This grid-based precision ASP was associated with sustained reductions in antimicrobial use and costs, and improved clinical outcomes. It was also associated with changes in the temporal relationship between AUD and MDRO detection rates. These alterations suggest this approach may mitigate selective pressure driving resistance, although causality cannot be established in this observational study. This framework may serve as a policy-aligned reference for large tertiary hospitals and provide useful insights to inform local and national antimicrobial stewardship initiatives.
Other specific DSP article suggested by Editorial Board
Diagnostic tests for urinary tract infections and antimicrobial resistance-a reality check between diagnostic innovation and implementation: a critical narrative review.
Authors: Mohan V, et al
Abstract
Urinary tract infections (UTIs) are a significant health concern worldwide, leading to substantial health and economic burden and contributing to the rise of antimicrobial resistance (AMR). Although there has been significant advancement in diagnostic technologies starting from conventional dipstick urinalysis to molecular assays and artificial intelligence (AI)-supported platforms, their clinical utility and impact still remain unclear. This is fundamentally due to the systemic barriers that hinder the implementation including cost, policy, and limitations to integrate into frontline healthcare and adoption by insurance agencies. This review focuses on critically reviewing UTI epidemiology, current and emerging diagnostics, and their significance in antimicrobial stewardship. We emphasise that bridging the gap between diagnostic innovation and clinical practice is essential to achieving meaningful milestones in AMR reduction. We are primarily arguing that addressing the policy inertia to diagnostic deployment with stewardship strategies is a crucial step for improving patient healthcare outcomes and preserving antimicrobial efficacy.