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Antibiotic prescription and antimicrobial resistance are parallel to each other. Misuse of antibiotics can increase health system costs and more importantly, morbidity and mortality, due to the emerging multi-drug resistant pathogens. Implementation of antibiotic stewardship programs in the hospital wards and intensive care units are a well-known action, however, there is an attention deficit regarding this activity in emergency department, the portal of admission to the wards. Therefore, making a specific plan with leadership of clinical pharmacists is highly desirable. Key words: Antimicrobial resistance, Emergency department, Clinical pharmacists

Background: Acinetobacter baumannii (AB) was declared an antibiotic-resistant “Priority 1 pathogen” by WHO. We sought to investigate the predisposing risk factors to this pathogen. Methods: In a retrospective study, adults who were admitted to Sohar hospital during 2016-2017 and had a positive laboratory-confirmed culture of AB were studied.We classified patients into 2 groups based on 30-day, all-cause mortality and compared the characteristics. Exploratory classification and regression tree (CART) analysis was performed to explore risk factors for mortality to include to a logistic regression model. Results: A total of 321 patients were included, age was (Mean±SD) 57.42±20.22, male gender was 180(56.07%), mortality was 140(44%). Survivors vs deceased had; length of stay 38.25±88.74 vs 51.31±79.19 (p=0.002),multi-drug resistantisolates 134(51.34%) vs 127(48.66%) p=<0.001, critical care admission 35(38.04%) vs 57(61.96%) p=<0.001, comorbidities 114(47.50%) vs 126(52.50%) p=<0.001 and history of invasive procedures 82(59.85%) vs 55(40.15%) p=0.27. Logistic regression revealed that the odds of dying increase by a factor of 1.044 for every additional year of age, 1.844 times higher for male compared to female, 4.412 times higher for patients admitted into critical care units compared to general wards, 3.138 times higher for patients admitted with a diagnosis of infection, 2.356 times higher for patients with hospital-acquired AB infection compared to community-acquired. Conclusion: Both modifiable and non-modifiable risk factors are associated with mortality and overall health status may contribute to infection outcome. Stabilization of comorbidities and effective antimicrobial treatment could be the mainstay of successful prevention.

COVID-19 is the most important matter in the medical field worldwide in 2020. Although COVID-19 is a viral disease, the threshold to antibiotic prescription for COVID-19 patients is low, partly because of WHO recommendations and previous experiences from influenza, despite the lack of strong evidence of co-infection or superimposed bacterial infection in COVID-19 patients. Antibiotic stewardship program (ASP) could play an important role in this period, otherwise, we will face a crisis of superbugs in the early future. Keywords:  COVID-19, Antibiotic stewardship program (ASP), Superbugs

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