A stepwise introduction of a successful antimicrobial stewardship program

Abstract

ObjectivesTo analyze and evaluate the safety and cost-effectiveness of a gradually-implemented antimicrobial stewardship programs (ASP) in a tertiary care center.MethodsProspective data were collected from an ASP that was gradually introduced between April 2012 and December 2013 in 6 hospital departments, over successive periods of 3 months each. A multidisciplinary team supervised antibiotic use and regulated pharmacy dispensations of a list of restricted antimicrobials (RAs). Indicators were prospectively monitored and included hospital mortality as the safety indicator; incidence of multi-drug resistance (MDR) infections as the effectiveness indicator, RA cost savings as the cost-effectiveness indicator and RA consumption indicated the process implementation.ResultsBetween 2012 and 2014, dispensations of RAs decreased by 67% and prescriptions by 75%; no increase in mortality rate was observed. Microbiologically, there was a decreasing trend of incidence across all monitored infections, but this was only significant for Acinetobacter baumannii (p=0.007). Cost analysis showed a decrease in expenditure for RAs, with an average monthly saving of up to 326,020USD.ConclusionsStepwise implementation of ASPs is a safe and cost-effective strategy for improving antibiotic prescribing practice and to reduce multi-drug resistance.

Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study

“…At a hospital level, evidence suggests the implementation of ASPs in some Saudi tertiary hospitals [7][8][9] and these ASPs are mainly led by infectious diseases (ID) consultants, with limited input from microbiologists and hospital pharmacists [7,8]. However, due to the shortage of ID consultants and microbiologists [2], these antimicrobial stewardship initiatives face sustainability challenges in tertiary care and are less likely to be implemented in secondary care where adoption of ASPs remains low [10].…”

Implementasi Antimicrobial Stewardship Program di Kawasan Asia: Sebuah Kajian Sistematis

“…Beberapa artikel penelitian dalam kajian sistematis ini menunjukkan adanya penurunan temuan beberapa patogen resisten setelah diimplementasikannya ASP, antara lain seperti methicillin-resistant Staphyloccus aureus (MRSA), 33,35,47,48 carbapenem-resistant Acinetobacter baumanii 34,35 , extended spectrum beta-lactamase (ESBL)-producing Eschericia coli, 35 ESBL-producing Klebsiella pneumoniae, 35 dan multi-drug resistant (MDR)-Acinetobacter baumanii. 51 Namun demikian, dalam kajian sistematis ini juga ditemukan bahwa beberapa jenis patogen resisten justru mengalami peningkatan pada periode setelah implementasi ASP. 33,34 Hal ini dapat dipahami dengan mempertimbangkan bahwa beberapa mekanisme resistensi dapat berkembang dan disebarkan antarjenis patogen yang berbeda melalui plasmid.…”

“…Dampak positif terakhir dari implementasi ASP ialah adanya penurunan biaya pengadaan (analisis dilakukan menggunakan perspektif rumah sakit) atau biaya penggunaan antibiotik (analisis dilakukan menggunakan perspektif pasien). 35,38,42,44,45,[47][48][49][50][51][52] Penurunan biaya tersebut dapat disebabkan oleh keberhasilan tim ASP dalam memberikan rekomendasi kepada dokter mengenai penghentian penggunaan antibiotik pada kasus yang tidak terbukti infeksi bakteri, 43,45 memperpendek waktu penggunaan antibiotik, 40,42,49 dan menurunkan jumlah penggunaan antibiotik kombinasi. 28,29 Meski demikian, perlu disampaikan bahwa rekomendasi perubahan atau penghentian terapi antibiotik tidak selalu diterima oleh dokter; 43 besar persentase penerimaan dokter terhadap rekomendasi yang diberikan berkisar antara 52% sampai 74,5%.…”

“…Perlu diingat kembali bahwa implementasi ASP membutuhkan investasi sumber daya manusia dan sarana prasarana, antara lain teknologi informasi, fasilitas untuk melakukan kultur bakteri, kebijakan rumah sakit (termasuk tugas dan wewenang tim ASP), dokumen penunjang ASP (termasuk pedoman terapi atau clinical pathway lokal rumah sakit), dan tenaga kesehatan dengan kepakaran khusus di bidang infeksi. 28,30,[33][34][35][36]40,42,45,49,51 Investasi tersebut dapat dipersepsikan sebagai sebuah investasi yang mahal bagi beberapa institusi kesehatan. Namun demikian, sebuah artikel penelitian menunjukkan jika penghematan biaya terkait pengadaan antibiotik setelah implementasi ASP dapat digunakan untuk membiayai kebutuhan implementasi ASP.…”

Economic Evaluations on Antimicrobial Stewardship Programme: A Systematic Review

“…computerisation of records, decision support system) [5]. Numerous studies [6][7][8] have shown the effectiveness of ASP and its interventions; and recently, there is an _________________________________________ increasing emphasis in evaluating cost-effectiveness upon implementation of these interventions. The recent reviews involved a large variation in the method and depth of ASP being economically evaluated (i.e.…”