Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore

Yeo, Cheo Lian; Chan, Douglas S.; Earnest, Arul; Wu, Tuck Seng; Yeoh, Siang Fei; Lim, Robert B.; Jureen, Roland; Fisher, Dale; Hsu, Li Yang

doi:10.1007/s10096-011-1351-6

Cited by 70 publications

(74 citation statements)

References 17 publications

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“…The review of the reference lists of the full-texted articles yielded two additional studies. As a result, 26 studies coded from 25 articles (1 article presented data from two different hospitals [28]) were included in our meta-analysis. The information extracted from individual studies is exhibited in Table 1, and the detailed selection process is illustrated in a flow chart (Fig.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Karanika

Paudel

Grigoras

et al. 2016

Antimicrob Agents Chemother

308

192

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bThe implementation of antimicrobial stewardship programs (ASPs) is a promising strategy to help address the problem of antimicrobial resistance. We sought to determine the efficacy of ASPs and their effect on clinical and economic parameters. We searched PubMed, EMBASE, and Google Scholar looking for studies on the efficacy of ASPs in hospitals. Based on 26 studies (extracted from 24,917 citations) with pre-and postimplementation periods from 6 months to 3 years, the pooled percentage change of total antimicrobial consumption after the implementation of ASPs was ؊19.1% (95% confidence interval [CI] ‫؍‬ ؊30.1 to ؊7.5), and the use of restricted antimicrobial agents decreased by ؊26.6% (95% CI ‫؍‬ ؊52.3 to ؊0.8). Interestingly, in intensive care units, the decrease in antimicrobial consumption was ؊39.5% (95% CI ‫؍‬ ؊72.5 to ؊6.4). ). Hospital ASPs result in significant decreases in antimicrobial consumption and cost, and the benefit is higher in the critical care setting. Infections due to specific antimicrobial-resistant pathogens and the overall hospital length of stay are improved as well. Future studies should focus on the sustainability of these outcomes and evaluate potential beneficial long-term effects of ASPs in mortality and infection rates.A bout one-third of the hospitalized patients and more than two-thirds of critically ill patients are on antimicrobial therapy at any time (1, 2), and up to half of antibiotic prescriptions are inappropriate or not necessary (3). In 2013, the Centers for Disease Control and Prevention (CDC) reported that about 2 million patients are infected yearly with antimicrobialresistant organisms in the United States, and about 23,000 deaths are directly attributed to these infections (3). This resulted in a call to action for acute care hospitals to implement antimicrobial stewardship programs (ASPs) (4, 5), a term that is used to describe the integrated strategy of improving antimicrobial use in order to enhance patient outcomes, reduce antimicrobial cost, and minimize the side effects associated with antimicrobial use, including drug resistance and nosocomial infections (4, 6, 7). Although there are studies that have already presented data on the efficacy of ASPs in the inpatient setting (8-10), limitations compromise their generalization (i.e., the studies were only conducted in the United States [8], age and study design limitations [9], a lack of clinical outcomes [10], etc.). The purpose of our systematic review and meta-analysis was to measure the efficacy of the implementation of an ASP expressed in daily defined doses (DDD) per 1,000 patient days in the hospital setting independently of the age and study design and to assess the subsequent clinical and economic outcomes. MATERIALS AND METHODSThis systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol (11).Search strategy. A systematic electronic search of PubMed, EMBASE, and Google Scholar databases was performed for pertinent studies up t...

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Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Karanika

Paudel

Grigoras

et al. 2016

Antimicrob Agents Chemother

308

192

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“…ID physicians provide a standard referral service whereas the prospective audit and feedback system of our ASP is also standard and has been described elsewhere [4,5]. Clinical and demographic data were extracted from our ASP database as well as the hospital electronic records.…”

Section: Setting and Methodsmentioning

confidence: 99%

“…In our institution, where a prospective audit and feedback ASP has been established since 2009 [4], we have consistently taken the last approach. We present herein our experience where ASP and ID physicians provide independent assessments and recommendations, analyzing the outcomes of a large subset of cases where the recommendations have differed.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital

Yeo

Chung

Chan

et al. 2013

Antimicrob Resist Infect Control

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BackgroundThe optimal way for antimicrobial stewardship programs (ASPs) to interact with existing infectious disease physician (IDP) services within the same institution is unknown. In our institution, IDPs and our prospective audit and feedback ASP operate independently, with occasionally differing recommendations offered for the same inpatient. We performed a retrospective audit on inpatients that had been reviewed by both IDPs and ASP within a 7-day period, focusing on cases where different therapy-modifying recommendations had been offered. We analyzed the outcomes in inpatients where the ASP recommendations were accepted and compared these with the inpatients where the IDP recommendations were accepted instead. Outcomes assessed were 30-day mortality post-ASP review, unplanned re-admission within 30 days post-discharge from hospital, and clinical deterioration at 7 days post-ASP review.FindingsThere were 143 (18.9%) patients where differing recommendations had been offered, with primary physicians accepting 69.9% of ASP recommendations. No significant differences in terms of demographics, clinical characteristics, 30-day mortality, and re-admission rates were observed, although clinical deterioration rates were lower in patients where the ASP recommendation was accepted (8.0% vs. 27.9%; p = 0.002). On multivariate analysis, hematology-oncology inpatients were associated with unplanned readmission. Increasing age and hematology-oncology inpatients were associated with clinical deterioration 7 days post-recommendation, whereas acceptance of ASP recommendations was protective. No characteristic was independently associated with 30-day mortality.ConclusionIn conclusion, independent reviews by both IDPs and ASPs can be compatible within large tertiary hospitals, providing primary physicians even in situations of conflicting recommendations viable alternative antimicrobial prescribing advice.

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“…Many countries have few antibiotic prescription control policies in the hospital setting and either have no antibiotic stewardship programs in place or are just beginning to implement such programs; a recent international survey showed that just over half (53%) of Asian countries had any form of antibiotic stewardship in their hospitals, and of those that did, fewer than half had any national (42%) or regional (16%) antibiotic stewardship standards in place (170). In countries with fairly established antibiotic stewardship programs such as Singapore, adherence to antibiotic prescription recommendations seldom exceeded 75% in published reports (171,172). In India, it was reported that physicians were compensated by pharmaceutical companies and phar-macies for prescribing antibiotics (166), but it is unclear how prevalent this practice is in other countries.…”

Section: Drivers Of Carbapenem-resistant Gram-negative Bacteriamentioning

confidence: 99%

Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

et al. 2017

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SUMMARY Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.

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Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore

Cited by 70 publications

References 17 publications

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital

Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

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