Poor compliance with an antibiotic directive – a call for intensified monitoring.

In April 2017, the Central Denmark Region Antibiotic Stewardship Committee issued a directive to reduce the general use of piperacillin-tazobactam and to prescribe narrow spectrum antibiotics for mild and moderate pneumonia. The directive was distributed to all regional hospital clinicians.
Electronic medical records were used to obtain de-identified details of all antibiotics administered (together with diagnosis codes) to all in-hospital patients (pre- and post-directive) in the 9 regional hospitals. We utilized average moving range statistical process control charts to analyze pre- and post-directive variation in antibiotic usage patterns.
Upon the distribution of the directive, a period of decline of the overall usage of piperacillin-tazobactam ensued. Rather than benzylpenicillin, as recommended for pneumonia, the initial decline in piperacillin/tazobactam usage was accompanied by increased use of cefuroxime.
A steward-directed reduction of piperacillin-tazobactam usage was accompanied by a less desirable usage of a broad-spectrum alternative. Future antibiotic stewardship initiatives will hopefully benefit from close monitoring and timely feedback to clinicians. A dialogue with clinicians based on near real-time data is predicted to improve antibiotic stewardship actions.