Abstract
Antimicrobial stewardship (AMS) program promotes the judicious use of antimicrobials. Hence, this study was conducted to analyze the impact of stewardship on the prescribing pattern of cefuroxime injection among the surgeons as perioperative antimicrobial prophylaxis (PAP). This study was conducted retrospectively in Malaysia. Various outcomes were measured including cefuroxime usage, compliance with the guidelines, surgical site infections, and cost savings. A total of 1,601 patients were recruited in the study. In terms of usage, the total defined daily dose (DDD) prior to the intervention was 202 DDD/100 procedures compared to that after intervention which was 144 DDD/100 procedures (p < 0.05). On the other hand, the excessively long administration of PAP dropped from 94.4 to 30.3% (p < 0.001). Focusing on the compliance with the newly developed local guidelines, it has increased from 53 to 94.3% after the interventions were made (p < 0.001), whereas the rate of surgical site infections was reduced from 17.0 to 9.0%. The cost of antibiotic being used has significantly reduced after the study intervention (p = 0.007). The quality of PAP directly impacts the antimicrobial usage, the surgical site infections, and the total cost involved. Thus, it is crucial to maintain the standard of PAP at all times in healthcare settings.
Highlights
The irrational use of antibiotics constitutes an ultimate factor related to the development of antibiotic resistance which in turn necessitates the enforcement of antimicrobial stewardship programs in the healthcare
Our data revealed that cefuroxime consumption had reduced significantly after the implementation of antimicrobial stewardship strategies to raise the quality of perioperative antimicrobial prophylaxis (PAP)
It is crucial to calculate the antibiotic consumption for PAP using the anatomical therapeutics chemical (ATC)/Defined daily dose (DDD) system in order to attain a general standardization as to equate antibiotic usages in other healthcare centers
Summary
The irrational use of antibiotics constitutes an ultimate factor related to the development of antibiotic resistance which in turn necessitates the enforcement of antimicrobial stewardship programs in the healthcare. Monitoring antibiotic usage is a recommended component of antimicrobial stewardship programs, providing information about the pattern and trends of usage at intrafacility and inter-facility level. These data would provide evidence of injudicious use and reflects the necessity to conduct additional audit or interventions. Defined daily dose (DDD) had been in use to standardize the unit of comparison worldwide. It is the average of the maintenance dose of a single antibiotic in its main indication for adults per day. It was recommended to express DDD per 100 bed-days in hospitals and DDD per 1,000 inhabitant-days for outpatients as to express the actual usage (Hutchinson et al, 2004; Dellit et al, 2007; Pope et al, 2009)
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