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In November 2007,in order to prevent the emergence of drug-resistant bacteria,we established a notification system concerning usage of broad-spectrum antimicrobials (carbapenems,fourth-generation cephalosporins,quinolones,and antimethicillin resistant Staphylococcus aureus (MRSA) agents),and linked it to a hospital information system.When ordering any of the antimicrobials mentioned above,physicians need to input the reason for prescribing it as well as the status of submitted bacterial cultures,and the period of administration is restricted to a maximum of four days including the day of order entry.In order to evaluate the system,we compared the amounts of regulated antimicrobial agents prescribed each month,the number of patients they were administered to,culture submission rate,the susceptibility rate of Pseudomonas aeruginosa for carbapenems and number of Clostridium difficile toxin A samples,between 1 year before the introduction of the system and 1 year after it was introduced.While there was no decrease in the amount of the regulated antimicrobials prescribed overall,there was a significant decrease in the amount of fourth-generation cephalosporins prescribed (p<0.05).The total cost of the antimicrobials did not decrease because the amounts of unregulated antimicrobials increased significantly (p=0.0002).The proportion of patients using regulated antimicrobials decreased significantly,from 17.3% to 13.8% (p<0.0001),and the frequency of ordering blood cultures increased from 26.1% to 53.8% (p<0.0001).In addition,the susceptibility rates of Pseudomonas aeruginosa for meropenem and imipenem/cilastatin significantly improved (p=0.0325,p=0.0188),and the number of Clostridium difficile toxin A samples decreased (p=0.0365).In conclusion,a hospital information system-linked prior notification system concerning broad-spectrum antimicrobials can make a useful contribution to preventing the emergence of bacterial resistance.

Evaluation of Hospital Information System-linked Notification System Concerning Usage of Broad-Spectrum Antimicrobials