{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:48:53Z","timestamp":1781916533052,"version":"3.54.5"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100013342","name":"Imperial Biomedical Research Centre","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013342","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Westminster Medical School Charity Trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Antimicrobial overuse causes increased antimicrobial resistance in ICUs; antimicrobial stewardship programmes (ASPs) aim to optimize usage. Following an MDR Acinetobacter baumannii (MRAb) outbreak in 2008, an ASP was implemented at a London ICU, and then continued as a long-term programme. This study aimed to determine long-term changes in antimicrobial prescribing 9\u2005years on.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were collected from ICU patients in 2008 immediately before ASP implementation, and thereafter for 6\u2005month cohort periods in 2010\u20132011, 2012 and 2017. Antimicrobial usage in DDD per 1000 occupied bed days (OBD) were compared. Multivariate linear regression models for antimicrobial days were fitted, adjusting for APACHE II score and patient days. Antimicrobial resistance in Pseudomonas aeruginosa (as an indicator organism) was compared across cohort periods.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Across 400 patients over 9\u2005years, antimicrobial use changed significantly (P\u200a&amp;lt;\u200a0.011) and remained lower in all post-ASP cohorts compared with pre-ASP [(2008; 1827\u2005DDD\/1000\u2005OBD), (2010; 1264\u2005DDD\/1000\u2005OBD), (2012; 1270\u2005DDD\/1000\u2005OBD) and (2017; 1566\u2005DDD\/1000\u2005OBD)]. There was reduction in usage of all antimicrobial classes except \u03b2-lactams (where there was no significant increase nor decrease, P\u200a=\u200a0.178) and aminoglycosides (where there was a significant increase in usage, P\u200a&amp;lt;\u200a0.0001). The latter was temporally associated with restrictions on specific carbapenems. There was an increase in carbapenem-resistant P. aeruginosa in 2012 only (P\u200a=\u200a0.028) but not subsequently.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Following ASP implementation after an outbreak of MRAb, reduced antimicrobial prescribing was maintained 9\u2005years on. We identify several factors influencing successful long-term maintenance of ASPs in ICUs.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlac108","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T18:59:03Z","timestamp":1665428343000},"source":"Crossref","is-referenced-by-count":3,"title":["Evaluating the long-term impact of an antimicrobial stewardship programme in a Central London mixed medical and surgical intensive care unit"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7054-1414","authenticated-orcid":false,"given":"Shivani","family":"Singh","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus, London SW7 2AZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Ark","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus, London SW7 2AZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Tatlock","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust , 369 Fulham Road , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundhiya","family":"Mandalia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus, London SW7 2AZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Chung","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust , 369 Fulham Road , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berge","family":"Azadian","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus, London SW7 2AZ , UK"},{"name":"Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust , 369 Fulham Road , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Hughes","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust , 369 Fulham Road , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabeela","family":"Mughal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus, London SW7 2AZ , UK"},{"name":"Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust , 369 Fulham Road , UK"},{"name":"North West London Pathology, Imperial College Healthcare NHS Trust , Fulham Palace Road, London W6 8RF , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7095-7922","authenticated-orcid":false,"given":"Luke S P","family":"Moore","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus, London SW7 2AZ , UK"},{"name":"Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust , 369 Fulham Road , UK"},{"name":"North West London Pathology, Imperial College Healthcare NHS Trust , Fulham Palace Road, London W6 8RF , UK"},{"name":"NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London , Du Cane Road, London W12 0NN , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-8966","authenticated-orcid":false,"given":"Suveer","family":"Singh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London , South Kensington Campus, London SW7 2AZ , UK"},{"name":"Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust , 369 Fulham Road , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"key":"2022101012050801600_dlac108-B1","author":"WHO"},{"key":"2022101012050801600_dlac108-B2","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"key":"2022101012050801600_dlac108-B3","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/2110-5820-1-47","article-title":"The rising problem of antimicrobial resistance in the intensive care unit","volume":"1","author":"Brusselaers","year":"2011","journal-title":"Ann Intensive Care"},{"key":"2022101012050801600_dlac108-B4","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1001\/jama.2009.1754","article-title":"International study of the prevalence and outcomes of infection in intensive care 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