Implementing National Antimicrobial Stewardship Program (ASP): Our Singapore Story

Loo, Liwen; Lee, Winnie; Chlebicki, Piotr; Kwa, Andrea Lay-Hoon

doi:10.1093/ofid/ofw194.105

Cited by 3 publications

(3 citation statements)

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“…There is a well-functioning Scottish Antimicrobial Prescribing Group (SAPG), established in 2008, tasked with overseeing the pattern of antimicrobial usage in Scottish hospitals and implement antimicrobial stewardship programs in different hospitals [ 10 ]. Likewise, antibiotic prescribing in Singapore hospitals is highly regulated by antimicrobial stewardship units and often supplemented by relevant laboratory investigations [ 11 ]. In contrast, there is no such governing body in Bangladesh, both in government and private hospitals, and antimicrobial usage in hospitals across the country is largely empirical.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Molla¹,

Yeasmin²,

Islam

et al. 2021

Infection Prevention in Practice

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Background: As evidence is mounting regarding irrational and often unnecessary use of antibiotics during the COVID-19 pandemic a cross-sectional Point Prevalence Survey (PPS) (in accordance with WHO guideline) was conducted across COVID-19 dedicated wards in Dhaka Medical College and Hospital (DMCH). Methodology: Antibiotic usage data were collected from 193 patients at different COVID-19 dedicated wards at DMCH on 11 June 2020. Comparisons in antibiotic usage were made between different groups using Pearson chi-square and Fisher’s exact test. Result: Findings reveal all surveyed patients (100%) were receiving at least one antibiotic with 133 patients (68.91%) receiving multiple antibiotics. Overall, patients presenting with the severe disease received more antibiotics. Third-generation cephalosporins (i.e. ceftriaxone) (53.8%), meropenem (40.9%), moxifloxacin (29.5%), and doxycycline (25.4%) were the four most prescribed antibiotics among surveyed patients. Diabetes mellitus (DM) was independently associated with multiple antibiotic prescribing. Abnormal C-reactive protein (CRP) and serum d-dimer were linked with higher odds of multiple antibiotic prescribing among study patients. Conclusion: Prevalence of multiple antibiotic prescriptions was high among severely ill patients and those with abnormal CRP and d-dimer levels. Data regarding the quality of antibiotic prescribing were lacking.

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Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Molla¹,

Yeasmin²,

Islam

et al. 2021

Infection Prevention in Practice

View full text Add to dashboard Cite

show abstract

“…There is a well-functioning Scottish Antimicrobial Prescribing Group (SAPG), established in 2008, tasked with overseeing the pattern of antimicrobial usage in Scottish hospitals and implement antimicrobial stewardship programs in different hospitals [15]. Likewise, antibiotic prescription in Singapore hospitals is highly regulated by antimicrobial stewardship units and often supplemented by relevant laboratory investigations [16]. In contrast, there is no such governing body in Bangladesh, both in government and private hospitals, and antimicrobial usage in hospitals across the country is largely empirical.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: A Single Center Point-Prevalence Survey

Molla¹,

Yeasmin²,

Islam

et al. 2021

Preprint

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SummaryThere is a clear deficiency in antimicrobial usage data and ongoing stewardship programs both in government and private health care facilities in Bangladesh. As evidences are mounting regarding irrational and often unnecessary use of antibiotics during COVID-19 pandemic, a point prevalence survey (PPS) was conducted across COVID-19 dedicated wards in Dhaka Medical College and Hospital (DMCH). Antibiotic usage data were collected from 193 patients at different COVID-19 dedicated wards at DMCH between 21 May, 2020 and 10 June, 2020. Comparisons in antibiotic usage were made between different groups using Pearson chi-square and Fisher exact test. Factors associated with multiple antibiotic prescription were evaluated using binary logistic regression model.On survey date all (100%) patients were receiving at least one antibiotic with 133 patients (68.91%) receiving multiple antibiotics. Overall, patients presenting with severe disease received more antibiotics on average. Third generation cephalosporin ceftriaxone (53.8%), meropenem (40.9%), moxifloxacin (29.5%) and doxycycline (25.4%) were the four most prescribed antibiotics among survey patients. Among comorbidities diabetes mellitus (DM) was independently associated with increased antibiotic prescribing. Abnormal C-reactive protein (CRP) and serum d-dimer were linked with higher odds of antibiotic prescribing among survey patients. Overall, prevalence of antibiotic prescribing in COVID-19 patients at DMCH was very high. This could be attributed to a lack of clear treatment protocol against COVID-19 till date as well as lack of modern laboratory facilities to support judicial antibiotic prescribing in Bangladesh. A well-functioning antibiotic stewardship program in Bangladesh is required to prevent an impending health crisis.

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“…ASPs have increased appropriate antibiotic prescribing and reduced the length of hospital stay without compromising patient safety, providing valuable clinical and economic benefits [ 7 , 8 ]. However, antibiotic use remains high in many developed countries, with one in two hospitalised patients prescribed at least one antimicrobial agent per day [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

et al. 2021

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Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists’ perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social–ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians’ prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists’ antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.

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Implementing National Antimicrobial Stewardship Program (ASP): Our Singapore Story

Cited by 3 publications

References 0 publications

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: Findings from a Single Center Study

Antibiotic Prescribing Patterns at COVID-19 Dedicated Wards in Bangladesh: A Single Center Point-Prevalence Survey

Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

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