{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T08:52:34Z","timestamp":1784796754079,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T00:00:00Z","timestamp":1566518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Implementing a successful antimicrobial stewardship program (ASP) is difficult for non-academic community (NAC) hospitals due to insufficient infrastructure. Aim: We evaluated the impact of an infectious disease specialist (IDS) on implementing an ASP in a resource-limited setting in Korea. Methods: A retrospective study was performed at a NAC hospital between June 2015 and August 2018. An IDS has led an ASP at the hospital since June 2017. We used an interrupted time series analysis to evaluate longitudinal effects of the IDS-led ASP on the amount of antibiotic use and incidence of multidrug-resistant organism (MDRO) acquisition. Findings: Total antibiotic use changed from 698.82 \u00b1 74.41 to 602.09 \u00b1 69.94 defined daily dose\/1000 patient-days (PDs) after intervention. An immediate reduction in the use of carbapenems, glycopeptides, penicillins, and other antibiotics followed the IDS-led ASP. The 3rd\/4th generation cephalosporins and carbapenems prescription rates decreased in slope after the intervention. Incidence of MDRO acquisition changed from 1.38, 0.78, and 0.21\/1000 PDs to 1.06, 0.15, and 0.32\/1000 PDs in methicillin-resistant Staphylococcus aureus, multidrug-resistant Acinetobacter baumannii, and multidrug-resistant Pseudomonas aeruginosa, respectively. The incidence of methicillin-resistant Staphylococcus aureus and multidrug-resistant Acinetobacter baumannii acquisition immediately decreased following intervention. Conclusion: An IDS can implement a successful ASP by reducing antibiotic consumption and MDRO acquisition at resource-limited NAC hospitals.<\/jats:p>","DOI":"10.3390\/jcm8091293","type":"journal-article","created":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T04:38:23Z","timestamp":1566794303000},"page":"1293","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of an Infectious Disease Specialist on an Antimicrobial Stewardship Program at a Resource-Limited, Non-Academic Community Hospital in Korea"],"prefix":"10.3390","volume":"8","author":[{"given":"Yong Chan","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea"},{"name":"Department of Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Yeon","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Hwa","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Young","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Jin","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9717-4327","authenticated-orcid":false,"given":"Nam Su","family":"Ku","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2775-3315","authenticated-orcid":false,"given":"Jun Yong","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-sup","family":"Yeom","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha Yan","family":"Kim","sequence":"additional","affiliation":[{"name":"Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,23]]},"reference":[{"key":"ref_1","first-page":"277","article-title":"The antibiotic resistance crisis: Part 1: Causes and threats","volume":"40","author":"Ventola","year":"2015","journal-title":"PT"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(15)00474-2","article-title":"Access to effective antimicrobials: A worldwide challenge","volume":"387","author":"Laxminarayan","year":"2016","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3855\/jidc.3573","article-title":"Bacteriophage therapy: a potential solution for the antibiotic resistance crisis","volume":"8","author":"Golkar","year":"2014","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Infectious Diseases Society of America (2010). The 10 x \u201820 Initiative: Pursuing a global commitment to develop 10 new antibacterial drugs by 2020. Clin. Infect. Dis., 50, 1081\u20131083.","DOI":"10.1086\/652237"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1093\/cid\/ciw118","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":"Barlam","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/S1473-3099(17)30325-0","article-title":"Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: A systematic review and meta-analysis","volume":"17","author":"Baur","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S1473-3099(16)00065-7","article-title":"Current evidence on hospital antimicrobial stewardship objectives: A systematic review and meta-analysis","volume":"16","author":"Schuts","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1086\/592067","article-title":"The value of infectious diseases specialists: non-patient care activities","volume":"47","author":"McQuillen","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"ofv042","DOI":"10.1093\/ofid\/ofv042","article-title":"An audit-based, infectious disease specialist-guided antimicrobial stewardship program profoundly reduced antibiotic use without negatively affecting patient outcomes","volume":"2","author":"Nilholm","year":"2015","journal-title":"Open Forum Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"14757","DOI":"10.1038\/s41598-018-33201-8","article-title":"Impact of an infectious diseases specialist-led antimicrobial stewardship programmes on antibiotic use and antimicrobial resistance in a large Korean hospital","volume":"8","author":"Hwang","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/cid\/ciw323","article-title":"Antibiotic stewardship programs in U.S. acute care hospitals: findings from the 2014 National Healthcare Safety Network Annual Hospital Survey","volume":"63","author":"Pollack","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1093\/cid\/cix407","article-title":"Antibiotic stewardship in small hospitals: barriers and potential solutions","volume":"65","author":"Stenehjem","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S613","DOI":"10.1093\/ofid\/ofy210.1747","article-title":"The impact of infection control cost reimbursement policy on trends in central line-associated bloodstream infections","volume":"5","author":"Kwon","year":"2018","journal-title":"Open Forum Infect. Dis."},{"key":"ref_14","unstructured":"Clinical and Laboratory Standards Institute (2019, May 15). Performance standards for antimicrobial susceptibility testing. 27th ed. CLSI supplement M100. Available online: https:\/\/www.researchgate.net\/profile\/Nikolaos_Andritsos\/post\/Where_to_find_MICs_of_antimicrobial_agents\/attachment\/59d659e279197b80779af319\/AS%3A544238144323584%401506767893696\/download\/2017_CLSI_M100_Performance+Standards+for+Antimicrobial+Susceptibility+Testing_27th+ed..pdf."},{"key":"ref_15","unstructured":"WHO Collaborating Centre for Drug Statistics Methodology (2019, May 15). ATC\/DDD index 2019. Available online: https:\/\/www.whocc.no\/atc_ddd_index\/."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1046\/j.1365-2710.2002.00430.x","article-title":"Segmented regression analysis of interrupted time series studies in medication use research","volume":"27","author":"Wagner","year":"2002","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e39","DOI":"10.1016\/j.ajic.2012.12.018","article-title":"Trend of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in an institution with a high rate of MRSA after the reinforcement of antibiotic stewardship and hand hygiene","volume":"41","author":"Kim","year":"2013","journal-title":"Am. J. Infect. Control"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1086\/662622","article-title":"Surveillance of overall hospital antibiotic consumption: is stratification according to hospital size the best method?","volume":"32","author":"Couderc","year":"2011","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1001\/jamainternmed.2016.5651","article-title":"Estimating national trends in inpatient antibiotic use among US hospitals from 2006 to 2012","volume":"176","author":"Baggs","year":"2016","journal-title":"JAMA Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S97","DOI":"10.1093\/cid\/ciu542","article-title":"Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention","volume":"59","author":"Pollack","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir365","article-title":"Antimicrobial stewardship programs in community hospitals: The evidence base and case studies","volume":"53","author":"Ohl","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"338","DOI":"10.7883\/yoken.JJID.2005.338","article-title":"Changes in antibiotic use, cost and consumption after an antibiotic restriction policy applied by infectious disease specialists","volume":"58","author":"Ozkurt","year":"2005","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1093\/cid\/cit610","article-title":"Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs","volume":"58","author":"Schmitt","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1086\/377286","article-title":"Concurrent antibiotic review programs\u2014A role for infectious diseases specialists at small community hospitals","volume":"37","author":"LaRocco","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/2047-2994-1-32","article-title":"Implementation of an antimicrobial stewardship program on the medical-surgical service of a 100-bed community hospital","volume":"1","author":"Storey","year":"2012","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"ofv064","DOI":"10.1093\/ofid\/ofv064","article-title":"An Infectious Diseases Physician-Led Antimicrobial Stewardship Program at a Small Community Hospital Associated With Improved Susceptibility Patterns and Cost-Savings After the First Year","volume":"2","author":"Day","year":"2015","journal-title":"Open Forum Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"943","DOI":"10.2146\/ajhp130602","article-title":"Implementation and first-year results of an antimicrobial stewardship program at a community hospital","volume":"71","author":"Bartlett","year":"2014","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1128\/AAC.01535-08","article-title":"Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa","volume":"53","author":"Pakyz","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s150100070010","article-title":"Influence of an infectious disease service on antibiotic prescription behavior and selection of multiresistant pathogens","volume":"28","author":"Lemmen","year":"2000","journal-title":"Infection"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S0140-6736(00)90015-1","article-title":"An antibiotic policy to prevent emergence of resistant bacilli","volume":"355","author":"Verhoeven","year":"2000","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3343\/alm.2017.37.3.231","article-title":"Increasing resistance to extended-spectrum cephalosporins, fluoroquinolone, and carbapenem in gram-negative bacilli and the emergence of carbapenem non-susceptibility in Klebsiella pneumoniae: Analysis of Korean Antimicrobial Resistance Monitoring System (KARMS) data from 2013 to 2015","volume":"37","author":"Kim","year":"2017","journal-title":"Ann. Lab. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/9\/1293\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:13:34Z","timestamp":1760188414000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/9\/1293"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,23]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,9]]}},"alternative-id":["jcm8091293"],"URL":"https:\/\/doi.org\/10.3390\/jcm8091293","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,23]]}}}