Implementation and Outcomes of an Advanced Antimicrobial Stewardship Program at a Quaternary Care Hospital in the United Arab Emirates

Abstract

BackgroundAntimicrobial stewardship programs (ASPs) are pivotal in healthcare facilities to curb antimicrobial resistance, improve patient outcomes and decrease healthcare costs. There is lack of literature on integrating the electronic medical record and electronic surveillance into antimicrobial stewardship in the Middle East. We describe our experience with implementing an advanced antimicrobial stewardship program using computerized clinical decision support system (CDSS) and electronic real-time surveillance software at a newly operated quaternary care hospital in the United Arab Emirates.MethodsThe ASP was implemented at hospital inception in April 2015. ASP utilized strategies described in the IDSA/SHEA guidelines including the use of rapid diagnostics, CDSS and electronic real-time surveillance. Antimicrobial therapy consumption was monitored monthly and reported in days of therapy per (DOT) per 1,000 inpatient days. Antimicrobial cost was analysed as total antimicrobials dispensed (AED) per 1,000 inpatient days. Antimicrobial therapy consumption and cost were analysed from the third-quarter of 2015 until the first quarter of 2017.ResultsAlthough our program has only been active for a little over 2 years, it has achieved significant decrease in the use of targeted antimicrobials. Carbapenem use decreased by 32%, from 105 to 71 DOT/1,000 inpatient days (P = 0.05). Anti-MRSA agents use decreased by 57% from 109 to 46 DOT/1,000 inpatient days (P = 0.003), and anti-pseudomonal β-lactam use decreased by 49% from 84 to 43 DOT/1,000 inpatient days (P = 0.015). Total cost of antimicrobial therapy decreased as well by 67% from 323 AED/1,000 inpatient days to 105 AED/1,000 inpatient days, (P = 0.01), with a hard cost total saving of 943,324 AED (256,338 USD) since program inception. There was no change in the severity of illness scores as measured by the hospital Case Mix Index (CMI) during the study period.ConclusionTo our knowledge this is the first advanced ASP program in the United Arab Emirates utilizing CDSS and electronic real-time surveillance. Our program demonstrated a significant decrease in the use and total cost of antimicrobials since hospital inception despite a significant increase in patient volume.Disclosures All authors: No reported disclosures.