Impact of antibiotic consumption post-implementation of antimicrobial stewardship in Orthopaedic and Obstetrics & Gynaecology (O&G) Department

Abstract

Background: Engagement of the surgical discipline into an active role in antimicrobial stewardship is a challenge. The usage of Ciprofloxacin and Cefoperazone/Sulbactam in the Orthopaedic and O&G, respectively, in Hospital Ampang was recorded to be the highest among Malaysian hospitals in 2017. Methods and materials: An antimicrobial stewardship team was established that consisted of leaders from the respective disciplines ie: Medical, Intensive Care Unit, Orthopaedics, Surgical, O&G. The objective of the team is to have ownership of antimicrobial issues regarding inappropriate usage of antibiotics or increase consumption in their own disciplines. The teams were given regular feedback regarding the antibiotic consumption and suggested personalised intervention for their departments by using the National Antibiotic Guideline 2014 as a guide. A dedicated pharmacist was also assigned to each department to carry out AMS activities. Results: There was a significant reduction in the Defined Daily Dose (DDD) of ciprofloxacin injection from 34.73 in 2017 to 0.92 in 2018 in the Orthopaedic Department (97.35% reduction). Marked decrement in cefoperazone/sulbactam usage in O&G was also seen, with DDD dropped from 6.67 in 2017 to 2.1 in 2018 (68.52% reduction). This achievement was resulted from changing the surgical prophylaxis antibiotic from cefoperazone/sulbactam to cefuroxime according to NAG. Conclusion: Engagement and ownership of AMS issues from the respective disciplines was the key step into making AMS implementation a priority and success in the Orthopaedic and O&G Department. This had led to a significant reduction in the usage of ciprofloxacin and cefoperazone/sulbactam in Hospital Ampang. Continued engagement is important to sustain this success.