National Antimicrobial Stewardship Programme Research Articles

Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND – modified Delphi procedure

ABSTRACT Introduction Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. Objectives The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. Methods A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. Results A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. Conclusion Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.

Evaluation of healthcare professionals' understanding of fluoroquinolones' safety profile, usage, and boxed warnings in Pakistan

IntroductionFluoroquinolones (FQs) is a distinct class of antibiotics which are prescribed and used quite frequently worldwide, despite the box warnings (BW) issued by Food and Drug Administration (FDA). Literature has shown in spite of BWs related to FQs there is minimal impact on health care professionals (HCPs) prescribing habits, potentially attributing towards limited and insufficient awareness. In Pakistan, FQs are mostly prescribed antibiotics for microbial treatments, therefore the purpose of this study was to determine the level of knowledge about the safety profile, use, and BW of FQs among HCPs working in Pakistan.MethodsA cross-sectional study was undertaken among the HCPs of Khyber Pakhtunkhwa province of Pakistan from October 2022 to December 2022. A validated questionnaire was used to assess the knowledge of HCPs regarding FQs, its safety profile and BW. A random convenient sample technique was used while recruiting HCPs in this study. As the HCPs comprised physicians, dentists, pharmacist and nurses, all were approached in person and the study objective was fully elaborated and explained to them. The statistic test like: one-way ANOVA, independent-t test, multivariate logistic regression were used keeping the p-value < 0.05 as statistically significant.ResultsA total of n = 250 HCPs were approached, of which n = 186 HCPs completed the questionnaire with a response rate of 74.4%. FQs prescribing pattern was only assessed among the prescribers, i.e., physicians and dentists (39/186). The mean knowledge score for indications was 5.29 ± 3.05, while for the adverse effects was 7.70 ± 2.61. The highest score for knowledge for indications and adverse effect score was achieved by physicians followed by dentist. The mean knowledge score for the BW was 3.46 ± 2.93 and among the HCPs for the BW of FQs, 20.4% of the HCPs had appropriate knowledge score (score ≥ 50%). The knowledge score was significantly higher in males (p = 0.039), dentists (p = 0.001), HCPs having master/specialization level of education (p = 0.003), HCPs working in government sector hospitals (p = 0.010) and secondary care hospitals (p = 0.001) while the multivariate logistic regression analysis showed that HCPs working in primary care hospital (OR: 6.2) and secondary care hospital (OR: 20.3) were associated with the tendency to achieve 50% or above knowledge score.Conclusion Findings of this study reveals the unsatisfactory knowledge of HCPs regarding the safety profile, use, and BW of FQs putting patients at heightened risks of FQs associated AEs. Therefore, it is crucial to implement a national antimicrobial stewardship program, seminars and lectures aimed at continuously updating the knowledge of HCPs, regardless of their specialties, and effectively restrict the misuse of antimicrobial and disseminate FDA BWs in clinical practice.

Acinetobacter baumannii: A multidrug-resistant pathogen, has emerged in Saudi Arabia.

A significant opportunistic pathogen, Acinetobacter baumannii (A. baumannii) has evolved mechanisms of resistance to a wide variety of antimicrobials, including carbapenems. In this article, we assessed the prevalence, risk factors, antimicrobial sensitivity, and resistance mechanisms among A. baumannii in several locations in Saudi Arabia. Hospital-acquired infections caused by A. baumannii were prevalent in the country due to a variety of reasons, such as the high number of critically ill patients, the frequency of gastrointestinal colonization, and the widespread use of antimicrobial medications. There has been an increase in the frequency of A. baumannii strains that are resistant to several antimicrobials, including carbapenems. Hospitals are a breeding ground for multidrug-resistant A. baumannii due to the widespread use of broad-spectrum antibiotics, the potential for patient-to-patient transmission of the bacteria, the high risk of infection during invasive intensive care unit procedures, and the high frequency with which diabetic and cancer patients in hospitals undergo invasive diagnostic and therapeutic procedures. Combinations of colistin and tigecycline with carbapenems or other antibiotics remain the best treatment option and are relatively safe to treat patients with multidrug resistance (MDR) A. baumannii infections, despite the rising incidence of resistance to these drugs observed in many hospitals. The prevalence of multidrug-resistant A. baumannii in Saudi hospitals calls for in-depth research into the underlying molecular mechanisms of multidrug resistance. In addition, a better understanding of A. baumannii resistance patterns and the establishment of a treatment protocol to reduce the infection burden in Saudi Arabia could benefit from the implementation of a local antibiogram database in tandem with a national antimicrobial stewardship and infection prevention program.

Facilitators and barriers to implementing antimicrobial stewardship programs in public South African hospitals.

The South African National Department of Health released guidelines and recommendations for antimicrobial stewardship (AMS) programs to be established in public healthcare facilities. Their implementation remains challenged, especially in North West Province, where the public health system functions under severe strain. This research explored and interpreted the facilitators that strengthen and barriers that hinder the implementation of the national AMS program in public hospitals in North West Province. A qualitative design and interpretive descriptive approach enabled insight into the realities of AMS program implementation. Public hospitals in North West Province, sampled through criterion sampling (n = 5). Purposive criterion sampling of healthcare practitioners (n = 30) actively participating in AMS programs in the 5 sampled public hospitals. Qualitative, interpretive description with semi-structured individual interviews that were digitally recorded and transcribed. The ATLAS.ti version 8 software facilitated content analysis, followed by second-level analysis. In total, 4 themes, 13 categories, and 25 subcategories emerged. We detected dissonance between government AMS ideals and the realities of AMS program implementation in public hospitals. A multilevel AMS leadership and governance vacuum exists in a dysfunctional health ecosystem in which AMS must operate. Healthcare practitioners agreed on the importance of AMS despite different understandings of AMS and ineffective multidisciplinary teams. Discipline-specific education and training are essential for all AMS participants. AMS is essential yet complex, and its contextualization and implementation are underestimated in public hospitals. Recommendations are focused on a supportive organizational culture, contextualized AMS program implementation plans, and changes in management.

Point Prevalence Survey of Antimicrobial Utilization in a Tertiary Care Teaching Hospital and a Comprehensive Comparative Analysis of PPS across India

This study assessed antimicrobial prescription at our institute to promote rational antimicrobial use and implement customized antimicrobial stewardship programs. This study is a cross sectional point-prevalence survey on antimicrobial utilisation conducted at HAH Centenary hospital, New Delhi in April, 2019, over a period of 3 days. All in-patients were included in the analysis. However, neonates, emergency room patients and palliative care patients, orders for anti-viral, anti-fungal, anti-tubercular and anti-parasitic medications were excluded. SPSS version 13.0 was planned to be used for analysis of the statistical data. The number of patients admitted at the point of time of our survey was 217, out of which 101 (46.54%) patients were receiving antimicrobial agents (AMA) with 160 (73.73%) AMAs prescribed. 50 patients (49.5%) were prescribed AMAs for infections, whereas, 49 patients (48.51%) were prescribed AMAs prophylactically and 2 (1.98%) patients received AMAs for reasons not defined. The intensive care units exhibited 93.33% patients receiving antimicrobials. The most common indication was intra-abdominal infections (32.40%). The most commonly used antibiotics were beta-lactam antibiotics (60.62%). The study suggests a high rate of antimicrobial use and highlights areas for intervention for rational antimicrobial use. We propose to sensitise the government on initiating a national antimicrobial stewardship program such as the Global Point Prevalence Survey and facilitate evidence-based antimicrobial practice.

Compliance of imipenem and meropenem administration with the national antimicrobial stewardship program in a referral teaching hospital in Iran

ABSTRACT Introduction Considering the great significance of antimicrobial resistance, implementation of antimicrobial stewardship programs (ASPs) in healthcare facilities is of particular importance. This study aimed to evaluate the compliance of imipenem and meropenem administration with the ASP guidelines in a referral teaching hospital in Iran. Methods In this retrospective cross-sectional study, the medical records of patients, who received either imipenem or meropenem at xx Hospital in Semnan, Iran, from 21 March 2017 until 20 March 2019, were reviewed using the developed ASP, according to the instructions issued by the Ministry of Health of Iran. The obtained findings were recorded in a checklist consisted of six items. If the action taken for the patient complied with the item requirement specified in the ASP, it would receive a score of one; otherwise, a score of zero. The sum of scores (range: 0–6) was reported and analyzed. Data were analyzed in SPSS version 23, using Chi-square, ANOVA, and independent t-test, and P < 0.05 was considered as significant. Results The mean duration of imipenem/meropenem administration was 9.2 ± 8.0 days. A total of 6,032 imipenem/meropenem vials (1 g/vial) were prescribed during the study (meropenem for 210 patients and imipenem for 87 patients). In 64.2% of the patients, there was no indication, and the mean score of the subjects was 1.55 ± 1.2. The obtained score was three in 53 (17.8%) records and four in 18 (6.1%) records. The mean score of ASP in the intensive care units was higher, while it was lower in the surgical ward as compared to the other wards (P = 0.002). Discussion Antibiotic prescription was inappropriate in our center, and compliance with the ASP guidelines was very low, especially in the surgical wards. It seems necessary to take effective steps for planning continuing education programs on rational antibiotic prescription and supervision of prescription patterns.

POSA238 Hospital Length of Stay and Antibiotic Prescription Practices for Patients Diagnosed with Gram Negative Infections - Evidence from Hospitals in Romania

ECDC indicates that Romania is among the member states with the highest levels of antimicrobial resistance (AMR) in Europe. However, there is no National Antimicrobial Stewardship Program (ASP) implemented to facilitate national guidelines on antibiotic prescription. Furthermore, studies using local hospital data monitoring cases with bacterial infections are scarce. The aim of this study is to estimate the inpatient average length of stay (ALoS) and observe the prescription practices when treating gram negative bacterial infections in public hospitals in Romania.

PRESCRIBING PATTERN OF INTRAVENOUS ANTIBIOTICS FOR HOSPITALIZED PATIENT IN HOSPITAL JERANTUT

Hospitalized patients are often prescribed with antibiotics and it can be a challenge for the prescriber. This study is conducted to review the prescribing pattern of intravenous antibiotics for hospitalized patients in Jerantut Hospital in accordance to the National Antibiotic Guideline and Antimicrobial Stewardship Program.

Development of a national neonatal intensive care unit-specific antimicrobial stewardship programme in Canada: protocol for a cohort study

IntroductionEarly empiric treatment with broad-spectrum antimicrobials is common in neonatal intensive care units (NICU) due to the non-specific clinical presentation of infection. However, excessive and inappropriate antimicrobial use can lead...

Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory

BackgroundAntimicrobial stewardship (AMS) describes activities concerned with safe-guarding antibiotics for the future, reducing drivers for the major global public health threat of antimicrobial resistance (AMR), whereby antibiotics are less effective in preventing and treating infections. Appropriate antibiotic prescribing is central to AMS. Whilst previous studies have explored the effectiveness of specific AMS interventions, largely from uni-professional perspectives, our literature search could not find any existing evidence evaluating the processes of implementing an integrated national AMS programme from multi-professional perspectives.MethodsThis study sought to explain mechanisms affecting the implementation of a national antimicrobial stewardship programme, from multi-professional perspectives. Data collection involved in-depth qualitative telephone interviews with 27 implementation lead clinicians from 14/15 Scottish Health Boards and 15 focus groups with doctors, nurses and clinical pharmacists (n = 72) from five Health Boards, purposively selected for reported prescribing variation. Data was first thematically analysed, barriers and enablers were then categorised, and Normalisation Process Theory (NPT) was used as an interpretive lens to explain mechanisms affecting the implementation process. Analysis addressed the NPT questions ‘which group of actors have which problems, in which domains, and what sort of problems impact on the normalisation of AMS into everyday hospital practice’.ResultsResults indicated that major barriers relate to organisational context and resource availability. AMS had coherence for implementation leads and prescribing doctors; less so for consultants and nurses who may not access training. Conflicting priorities made obtaining buy-in from some consultants difficult; limited role perceptions meant few nurses or clinical pharmacists engaged with AMS. Collective individual and team action to implement AMS could be constrained by lack of medical continuity and hierarchical relationships. Reflexive monitoring based on audit results was limited by the capacity of AMS Leads to provide direct feedback to practitioners.ConclusionsThis study provides original evidence of barriers and enablers to the implementation of a national AMS programme, from multi-professional, multi-organisational perspectives. The use of a robust theoretical framework (NPT) added methodological rigour to the findings. Our results are of international significance to healthcare policy makers and practitioners seeking to strengthen the sustainable implementation of hospital AMS programmes in comparable contexts.

Knowledge and perceptions of antimicrobial stewardship program among health-care students in Saudi Arabia

Background: National antimicrobial stewardship program (AMS) is an initiative to prevent antibiotic misadventures. Currently, AMS is not compulsory as part of the undergraduate health-care students in Saudi Arabia. Identifying gaps in knowledge and a better understanding of their perceptions about AMS could assist in recommendations for appropriate changes to the curricula that may lead to more appropriate use of antimicrobials within the multidisciplinary team. Objective: The objective of this study was to assess the AMS knowledge and perceptions among health-care students – pharmacy, medicine, dental, nursing, and microbiology. Methods: A cross-sectional, descriptive survey was conducted among health-care students of different colleges of Jazan University, Saudi Arabia. Collected data were analyzed using SPSS version 23. Results: A questionnaire was supplied to 563 students and 390 (69.27%) responded. AMS was known to 71% of the participants, while 50.3% were familiar with AMS in Saudi Arabia, with a significant difference among students of different health-care colleges. The broad appreciation of AMS goals, team members, and role of pharmacist was more among dental, microbiology, and pharmacy students as against nursing and general medicine. All health-care students possess good knowledge about causes of antimicrobial resistance (AMR). Formal training on AMS was received by merely 48.97% of the participants. A clear majority (80.8%) opined that better understanding of antimicrobial use is important for career, and 79.0% registered a need of incorporating AMS training in curricula. Conclusions: Concepts of AMS need to be included in the undergraduate health-care curricula to promote the rational use of antimicrobials and minimize incidences of AMR to improve clinical outcomes.

Establishing a baseline for a national paediatric antimicrobial stewardship programme.

The majority of antimicrobial stewardship programmes focus on prescribing in adult populations; however, there is a recognized need for targeted paediatric antimicrobial stewardship to improve the quality and safety of prescribing amongst this patient group. To describe the current epidemiology of antimicrobial prescribing in paediatric inpatient populations in Scotland to establish a baseline of evidence and identify priority areas for quality improvement to support a national paediatric antimicrobial stewardship programme. A total of 559 paediatric inpatients were surveyed during the Scottish national point prevalence survey of healthcare-associated infections and antimicrobial prescribing, 2016. The prevalence of antimicrobial prescribing was calculated and characteristics of antimicrobial prescribing were described as proportions and compared between specialist hospitals and paediatric wards in acute hospitals. Prevalence of antimicrobial use in paediatric inpatients was 35.4% (95% CI = 31.6%-39.4%). Treatment of community- and hospital-acquired infections accounted for 47.1% and 20.7% of antimicrobial use, respectively, with clinical sepsis being the most common diagnosis and gentamicin the most frequently prescribed antimicrobial for the treatment of infection. The reason for prescribing was documented in the notes for 86.5% of all prescriptions and, of those assessed for compliance against local policy, 92.9% were considered compliant. Data from national prevalence surveys are advantageous when developing antimicrobial stewardship programmes. Results have highlighted differences in the prescribing landscape between paediatric inpatient populations in specialist hospitals and acute hospitals, and have informed priorities for the national antimicrobial stewardship programme, which reinforces the need for a targeted paediatric antimicrobial stewardship programme.

The 2018 Lebanese Society of Infectious Diseases and Clinical Microbiology Guidelines for the use of antimicrobial therapy in complicated intra-abdominal infections in the era of antimicrobial resistance

BackgroundThe Lebanese Society of Infectious Diseases and Clinical Microbiology (LSIDCM) is involved in antimicrobial stewardship. In an attempt at guiding clinicians across Lebanon in regards to the proper use of antimicrobial agents, members of this society are in the process of preparing national guidelines for common infectious diseases, among which are the guidelines for empiric and targeted antimicrobial therapy of complicated intra-abdominal infections (cIAI). The aims of these guidelines are optimizing patient care based on evidence-based literature and local antimicrobial susceptibility data, together with limiting the inappropriate use of antimicrobials thus decreasing the emergence of antimicrobial resistance (AMR) and curtailing on other adverse outcomes.MethodsRecommendations in these guidelines are adapted from other international guidelines but modeled based on locally derived susceptibility data and on the availability of pharmaceutical and other resources.ResultsThese guidelines propose antimicrobial therapy of cIAI in adults based on risk factors, site of acquisition of infection, and clinical severity of illness. We recommend using antibiotic therapy targeting third-generation cephalosporin (3GC)-resistant gram negative organisms, with carbapenem sparing as much as possible, for community-acquired infections when the following risk factors exist: prior (within 90 days) exposure to antibiotics, immunocompromised state, recent history of hospitalization or of surgery and invasive procedure all within the preceding 90 days. We also recommend antimicrobial de-escalation strategy after culture results. Prompt and adequate antimicrobial therapy for cIAI reduces morbidity and mortality; however, the duration of therapy should be limited to no more than 4 days when adequate source control is achieved and the patient is clinically stable. The management of acute pancreatitis is conservative, with a role for antibiotic therapy only in specific situations and after microbiological diagnosis. The use of broad-spectrum antimicrobial agents including systemic antifungals and newly approved antibiotics is preferably restricted to infectious diseases specialists.ConclusionThese guidelines represent a major step towards initiating a Lebanese national antimicrobial stewardship program. The LSIDCM emphasizes on development of a national AMR surveillance network, in addition to a national antibiogram for cIAI stratified based on the setting (community, hospital, unit-based) that should be frequently updated.

An Assessment of Potential Unintended Consequences Following a National Antimicrobial Stewardship Program in England: An Interrupted Time Series Analysis.

The "Quality Premium" (QP) introduced in England in 2015 aimed to financially reward local healthcare commissioners for targeted reductions in primary care antibiotic prescribing. We aimed to evaluate possible unintended clinical outcomes related to this QP. Using Clinical Practice Research Datalink and Hospital Episode Statistics datasets, we examined general practitioner (GP) consultations (visits) and emergency hospital admissions related to a series of predefined conditions of unintended consequences of reduced prescribing. Monthly age- and sex-standardized rates were calculated using a direct method of standardization. We used segmented regression analysis of interrupted time series to evaluate the impact of the QP on seasonally adjusted outcome rates. We identified 27334 GP consultations and >5 million emergency hospital admissions with predefined conditions. There was no evidence that the QP was associated with changes in GP consultation and hospital admission rates for the selected conditions combined. However, when each condition was considered separately, a significant increase in hospital admission rates was noted for quinsy, and significant decreases were seen for hospital-acquired pneumonia, scarlet fever, pyelonephritis, and complicated urinary tract conditions. A significant decrease in GP consultation rates was estimated for empyema and scarlet fever. No significant changes were observed for other conditions. Findings from this study show that overall there was no significant association between the intervention and unintended clinical consequences, with the exception of a few specific conditions, most of which could be explained through other parallel policy changes or should be interpreted with caution due to small numbers.

The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care: An Interrupted Time Series Analysis.

The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. We used a national antibiotic prescribing dataset from April 2013 until February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (specific therapeutic group age/sex-related prescribing units), the number of broad-spectrum antibiotic items prescribed, and broad-spectrum antibiotic items prescribed, expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5933563 fewer antibiotic items prescribed during the 23 post-intervention months, as compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.

ISQUA18-2508An Assessment of Unintended Consequences in England Following a National Antimicrobial Stewardship Programme: An Interrupted Time Series Analysis

ISQUA18-2508An Assessment of Unintended Consequences in England Following a National Antimicrobial Stewardship Programme: An Interrupted Time Series Analysis

National Antimicrobial Stewardship Program in Saudi Arabia; Initiative and the Future

National Antimicrobial Stewardship Program in Saudi Arabia; Initiative and the Future

Reduction of Antimicrobial Resistance among Gram- Negative Pathogens after Antimicrobial Stewardship in Three Tertiary Egyptian Hospitals

BackgroundAntimicrobial resistance is an urgent healthcare threat. Monitoring and interventions to reduce antimicrobial resistance among Gram-negative rods (GNR) are essential.MethodsThe study was conducted over three years in three tertiary- care hospitals in Egypt during 2014- 2016. It included 578 GNR isolates from intra-abdominal infections (IAI), urinary tract infections (UTI) and respiratory tract infections (RTI). Identification of isolates was done by VITEK-2, and confirmed by MALDI-TOF at a central laboratory as part of Study for Monitoring Antimicrobial Resistance Trends (SMART). Susceptibility testing and molecular studies of resistance were conducted in the hospital laboratories. Starting from 2015, an antimicrobial stewardship (AMS) program was implemented in the 3 hospitals for fluoroquinolone restriction in empirical therapy, and early de-escalation of antimicrobial therapy.ResultsIn Phase 1 (before AMS), 578 isolates of Gram-negative bacilli (GNB) were studied. Enterobacteriaceae comprised 66% of the total isolates. K.pneumoniae and E.coli were the most common (29.8% and 29.4%), followed by Acinetobacter baumannii (21.1%) and P.aeruginosa (9.9%). K.pneumoniae and E.coli were the predominant organisms in IAI (30.5% and 30.1% respectively) and UTI (and 38.9% and 48.6% respectively), while Acinetobacter baumannii was the most prevalent in RTI (40.2%). ESBL producers were phenotypically detected in 53% of K.pneumoniae, 68% of E.coli and 64% of Proteus mirabilis. Amikacin, imipenem, ertapenem and piperacillin/tazobactam had the highest susceptibility (60.7%, 58%, 49.3% and 46.5% respectively).In Phase 2 (after AMS), 492 Gram-negative bacilli (GNB) were studied, showing similar distribution except for marked reduction in Acinetobacter baumannii(5.3% in IAI, 11.4% in RTI and 1% in UTI). ESBL continued to be high. Susceptibility to carbapenems increased to 87.1% for E.coli and 77.7% for all Enterobacteriaceae. PCR showed predominance of OXA-48- like (more than 50% and NDM (more than 40%), with low percentage of KPC2, VIM2 and IMP.ConclusionOur results show high ESBL and carbapenemases rates compared with the region that call for an urgent national AMS program and strict implementation of infection control measures.Disclosures A. El Kholy, MSD: Investigator, Research support; S. A. Girgis, MSD: Investigator, Research support; M. A. F. Shetta, MSD: Research Contractor, Research support; A. Ramadan, MSD: Investigator, Research support; D. H. AbdElhHamid, MSD: Investigator, Research support

Six years of a national antimicrobial stewardship programme in Scotland: where are we now?

BackgroundThe Scottish Antimicrobial Prescribing Group (SAPG) was established in 2008 to lead delivery of the national antimicrobial stewardship programme. We performed a national self-reported survey in 2014 to evaluate stewardship activities delivered by regional Antimicrobial Management Teams (AMTs). An on-line survey was developed utilising validated indicators from a published European study along with questions specific to the Scottish context. Descriptive statistics were used to evaluate the responses received.FindingsThe survey was completed by 14 of the 15 AMTs (response rate 93 %). Results demonstrated good compliance with 9 of the 10 key European indicators included in the survey; 7 (50 %) of AMTs achieved all 9 indicators and 14 (100 %) of AMTs achieved at least 6 out of 9 indicators (67 %). Progress was also demonstrated across a range of stewardship activities and areas for further work were identified.ConclusionsThe survey results suggest the national stewardship programme in Scotland has reached maturity but consolidation and ongoing development are required. Collaborative working between SAPG and AMTs together with central funding has been key to achieving this level of success.

Antibacterial usage in English NHS hospitals as part of a national Antimicrobial Stewardship Programme

Antimicrobial resistance (AMR) has become a global problem for health care services, with fewer antimicrobials entering the market and some pathogenic organisms becoming resistant to commonly used antimicrobials. Antimicrobial stewardship (AS), including evidence-based standard setting, education and communication, and audits of practice, has become a key method of preventing the rise in the rise in AMR. Data on antibiotic consumption are often obtained through prospective and retrospective point prevalence audits of antibiotic usage, but such studies are very resource intensive and only provide a snapshot of consumption. The objective of the study reported here was to examine longitudinal total antibacterial usage at a national level and cross-sectional usage at an individual hospital trust level using a commercial database that captures antimicrobial prescribing from at least 99% of English hospital Trusts.