{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T18:18:37Z","timestamp":1788805117050,"version":"build-2803163510"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP22K10547"],"award-info":[{"award-number":["JP22K10547"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Outstanding Research Group Support Program in Nagoya City University","award":["2530003"],"award-info":[{"award-number":["2530003"]}]},{"name":"Department of Clinical Infectious Diseases, Nagoya City University Graduate School of Medical Sciences"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Since antimicrobial shortages are becoming common owing to manufacturing issues and sudden demand, individualized antimicrobial optimization by infectious disease specialists is essential. We evaluated the effects of a 12-month antimicrobial stewardship program at a university-affiliated hospital in Japan during antimicrobial shortages. In this single-center retrospective observational study, from April 1, 2023, to March 31, 2025, we compared the pre-intervention (antimicrobial stewardship program without infectious disease specialists) and post-intervention (antimicrobial stewardship program with infectious disease specialists and formal consultation service) periods. The evaluated outcomes included antimicrobial use, microbiological indicators (number of culture specimens submitted and hospital-acquired resistant organisms), patient outcomes (in-hospital mortality and length of hospital stay), and antimicrobial costs. A Bayesian structural time-series analysis adjusted for seasonality was used to assess intervention effects. In total, 24,601 inpatients were included (11,782 before intervention and 12,819 after). Shortages affected nine intravenous and two oral antibiotics. The antimicrobial stewardship program team provided 1110 feedback instances (acceptance rate, 74.1%) and conducted 172 infectious disease consultations in the post-intervention period. Carbapenem use, antipseudomonal agent use, incidence of carbapenem-resistant\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    , and the cost of carbapenems per patient-day significantly decreased. Narrow-spectrum antibiotic use, anti-methicillin-resistant\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    agent use, all intravenous antimicrobial use, total intravenous and oral antimicrobials, and the number of inpatient specimens were significantly increased. All antimicrobial costs, in-hospital mortality, and length of hospital stay remained unchanged. Antimicrobial stewardship program supported by infectious disease specialists\/consultants significantly reduced carbapenem and antipseudomonal agent use without negatively affecting patient outcomes. These findings highlight infectious disease specialists\u2019 critical role in supporting effective antimicrobial stewardship programs, particularly during limited antimicrobial supply and increased clinical complexity.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0340599","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:41:12Z","timestamp":1770057672000},"page":"e0340599","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of an infectious disease specialist-led antimicrobial stewardship program and consultations during multiple antimicrobial shortages: A bayesian structural time-series analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6269-7884","authenticated-orcid":true,"given":"Naoya","family":"Itoh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobumasa","family":"Okumura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-4634","authenticated-orcid":true,"given":"Nana","family":"Akazawa-Kai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiharu","family":"Wachino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Kuriki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Kawabata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"issue":"4","key":"pone.0340599.ref001","doi-asserted-by":"crossref","first-page":"107456","DOI":"10.1016\/j.ijantimicag.2025.107456","article-title":"Antibiotic 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infections","volume":"26","author":"MN Mendez","year":"2006","journal-title":"Pharmacotherapy"},{"key":"pone.0340599.ref010","unstructured":"Centers for Disease Control and Prevention. Multidrug-resistant organism and Clostridioides difficile infection (MDRO\/CDI) module. https:\/\/www.cdc.gov\/nhsn\/PDFs\/pscManual\/12pscMDRO_CDADcurrent.pdf"},{"key":"pone.0340599.ref011","volume-title":"Performance standards for antimicrobial susceptibility testing","author":"CLSI Clinical and Laboratory Standards Institute","year":"2017","edition":"27"},{"issue":"5","key":"pone.0340599.ref012","doi-asserted-by":"crossref","DOI":"10.1128\/mSphere.00490-20","article-title":"Molecular and epidemiological characteristics of carbapenemase-producing klebsiella pneumoniae clinical isolates in Japan","volume":"5","author":"S Yonekawa","year":"2020","journal-title":"mSphere"},{"issue":"10","key":"pone.0340599.ref013","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofz389","article-title":"Eight-year experience of antimicrobial stewardship program and the trend of carbapenem use at a tertiary acute-care hospital in japan-the impact of postprescription review and feedback","volume":"6","author":"T Akazawa","year":"2019","journal-title":"Open Forum Infect Dis"},{"issue":"1","key":"pone.0340599.ref014","doi-asserted-by":"crossref","DOI":"10.1214\/14-AOAS788","article-title":"Inferring causal impact using Bayesian structural time-series models","volume":"9","author":"KH Brodersen","year":"2015","journal-title":"Ann Appl Stat"},{"issue":"2","key":"pone.0340599.ref015","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1128\/AAC.05560-11","article-title":"Changes in the use of broad-spectrum antibiotics after cefepime shortage: A time series analysis","volume":"56","author":"C Pl\u00fcss-Suard","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0340599.ref016","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jgar.2017.07.015","article-title":"Shifts in antimicrobial consumption and infection rates before and during a piperacillin\/tazobactam shortage","volume":"11","author":"ST King","year":"2017","journal-title":"J Glob Antimicrob Resist"},{"key":"pone.0340599.ref017","doi-asserted-by":"crossref","first-page":"157","DOI":"10.3389\/fmed.2020.00157","article-title":"Risks in antibiotic substitution following medicine shortage: A health-care failure mode and effect analysis of six european hospitals","volume":"7","author":"N Miljkovi\u0107","year":"2020","journal-title":"Front Med (Lausanne)"},{"issue":"10","key":"pone.0340599.ref018","doi-asserted-by":"crossref","DOI":"10.1093\/cid\/ciw217","article-title":"Implementing an antibiotic stewardship program: Guidelines by the infectious diseases society of america and the society for healthcare epidemiology of America","volume":"62","author":"TF Barlam","year":"2016","journal-title":"Clin Infect Dis"},{"issue":"6","key":"pone.0340599.ref019","doi-asserted-by":"crossref","first-page":"102710","DOI":"10.1016\/j.jiac.2025.102710","article-title":"Corrigendum to \u201cImpact of BD BACTEC blood culture bottle shortage on performance metrics: An interrupted time-series analysis at a Japanese university-affiliated hospital\u201d [J Infect Chemother (2025) 31(4) 102664]","volume":"31","author":"N Itoh","year":"2025","journal-title":"J Infect Chemother"},{"issue":"5","key":"pone.0340599.ref020","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1017\/ice.2021.203","article-title":"Antibiotic stewardship implementation at hospitals without on-site infectious disease specialists: A qualitative study","volume":"43","author":"DJ Livorsi","year":"2022","journal-title":"Infect Control Hosp Epidemiol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0340599","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T18:41:16Z","timestamp":1770057676000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0340599"}},"subtitle":[],"editor":[{"given":"Mabel Kamweli","family":"Aworh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0340599","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]}}}