Evaluation on the impact of antimicrobial stewardship programme (AMS) in a tertiary hospital

Abstract

Background: Antimicrobial Resistance (AMR) is a serious threat to global public health. Hence, in Malaysia, Antimicrobial Stewardship (AMS) was developed to optimize antimicrobial use in health care setting. Not many studies have been conducted and the impact of AMS in Hospital Serdang is unknown. This study was conducted to assess the impact of antimicrobial stewardship in Hospital Serdang. Methods and materials: Prospective observational cross-sectional study. Universal sampling where all patients intervened during AMS round (patient empirically started on carbapenem, vancomycin, and polymyxin B & E) in study period from 1st January 2017 to 31st December 2017. Patient's data were retrieved from the electronic hospital information system (eHIS) and ward medication charts. Clinical outcome includes clinical cure rate, discharged alive, mortality rate, readmission rate and length of stay were evaluated. Results: A total of 142 patients intervened in the AMS round throughout the study period. Majority of the patients were male (60.6%), mean age 54.1 years, with comorbidities (77.5%) and most of the antibiotics were initiated for respiratory tract infections (39.4%). Similar clinical cure rate (46.3% vs. 42.1%), discharged alive rate (72.4% vs. 73.7%) and mortality rate (27.6% vs. 26.3%) were demonstrated between interventions accepted group and rejected group. Readmission rate were 8.9% among accepted group and no readmission was reported in rejected group. De-escalation of antibiotic (42%) was the most common interventions accepted. This was followed by escalation of antibiotic, inappropriate choice of antibiotic, inappropriate dose, inappropriate duration, polypharmacy and inappropriate frequency. High acceptance rate (86.6%) of AMS interventions were demonstrated in this study. Conclusion: Implementation of AMS helps to guide physician in optimizing the appropriate use of antimicrobial therapy in healthcare setting.