Abstract
Backgrounds & Objective:Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital.Methods:An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above.Results:Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004).Conclusion:ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures.
Highlights
Antimicrobial resistance is an alarming public health threat that requires urgent global solution.11
In contrary to the recommendation by Infectious Disease Society of America (IDSA) antimicrobial stewardship program (ASP) Guidelines that suggested that ASP be administered by either infectious disease (ID) specialists or ID pharmacist[3], the most daunting challenge in building of the antimicrobial stewardship (AMS) team in our hospital was none of these in-house personnel were available to oversee the program in our hospital
The AMS team was placed under a consultant physician who was assigned as the chairperson for the Hospital Infection and Antibiotic Control Committee (HIACC)
Summary
Setting: An ASP was implemented at a non-profit, government-funded, district hospital, equipped with 268 beds including intensive care, and consisted of 7 major disciplines (medical, surgical, orthopedic, pediatric, anesthetic, obstetric & gynecology, and emergency department). After a baseline review of the hospital existing resources, procedures, and policies on antimicrobial use, a structured process for ASP had been developed locally at the end of year 2014. The structure of the ASP should conform and adaptable to available facility resources. Utilizing it as the backbone, the unique and hospital specific program was initiated locally with the appointment and identification of the roles of each team member involved. In contrary to the recommendation by Infectious Disease Society of America (IDSA) ASP Guidelines that suggested that ASP be administered by either ID specialists or ID pharmacist[3], the most daunting challenge in building of the AMS team in our hospital was none of these in-house personnel were available to oversee the program in our hospital. The AMS team was placed under a consultant physician who was assigned as the chairperson for the Hospital Infection and Antibiotic Control Committee (HIACC)
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