Abstract
BackgroundAntibiotics are miracles of science and critical for many surgical procedures. However, the emergence of multidrug resistant pathogens resulting from inappropriate antibiotic use is a threat to modern medicine. This study aimed to determine the appropriateness of antibiotic use, cost, consumption and impact of an antibiotic stewardship intervention round in a surgical ward setting.MethodsBaseline antibiotic utilisation was determined with a retrospective cross-sectional study in two surgical wards in a tertiary academic hospital in South Africa where medical records of 264 patients who received antibiotics were reviewed. In the second stage of the study, records of 212 patients who received antibiotics were reviewed during a weekly antibiotic stewardship intervention round. The volume of antibiotics consumed was determined using defined daily doses (DDDs)/1000 patients’ days, and the appropriateness of the antibiotic prescription for treatment was also determined using a quality-of-use algorithm.ResultsThere was a reduction in the volume of antibiotic consumption from a total 739.30 DDDs/1000 to 564.93 DDDs/1000 patient days, with reduction in inappropriate antibiotic use from 35% to 26% from baseline to antibiotic stewardship programme stages, respectively. There was an overall increase in culture targeted therapy in both wards in the antibiotic stewardship programme stage.ConclusionThe implementation of an antibiotic stewardship programme led to a reduction in antibiotic consumption and improvement in appropriate use of antibiotics.
Highlights
Antibiotics are a precious resource whose discovery has transformed modern medicine by playing a critical role in the fight against infectious diseases and decreasing mortality caused by bacterial infections.[1,2] The rapid development of resistance to available antibiotics by bacteria, and lack of development of new agents over the years has negatively affected this initial success.[2]
Amoxicillin/clavulanic acid was the most frequently used antibiotic (53%), followed by piperacillin/tazobactam (16%); while in the antibiotic stewardship programmes (ASP) stage, still the most used agent, the frequency of amoxicillin/clavulanic reduced to 34%, while piperacillin/tazobactam increased to 26% (Table 2)
Many ASPs have reported a reduction in length of hospital stays (LOS) during interventions,[22,31] in contrast, this study showed an increase in LOS
Summary
Antibiotics are a precious resource whose discovery has transformed modern medicine by playing a critical role in the fight against infectious diseases and decreasing mortality caused by bacterial infections.[1,2] The rapid development of resistance to available antibiotics by bacteria, and lack of development of new agents over the years has negatively affected this initial success.[2] Antibiotic resistance (ABR) is a global threat to both public health and economic stability, especially in developing countries. Despite advancements in prevention and control of infections, surgical site infections (SSIs) have remained leading cause for mortality and morbidity.[5] Patients with SSIs are more likely to be readmitted with a higher risk of death, than those without these infections, they require longer hospitalisation and incur considerable increases in healthcare costs.[5] Optimising antimicrobial use before, during or after surgical procedures is critical in addressing ABR, simultaneously reducing the burden of infection globally.[6] This requires a systematic approach by way of antibiotic stewardship to optimise rational antibiotic use. This study aimed to determine the appropriateness of antibiotic use, cost, consumption and impact of an antibiotic stewardship intervention round in a surgical ward setting
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