The implementation and outcome of a 2-year prospective audit and feedback based antimicrobial stewardship program at a private tertiary care hospital

Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review

“…The geographical origin of the 13 studies was as follows: United States ( n = 4) [ 19 , 21 , 23 , 24 ], United Kingdom ( n = 2) [ 30 , 31 ], India ( n = 2) [ 26 , 27 ], Germany ( n = 1) [ 22 ], Netherlands ( n = 1) [ 20 ], Jordan ( n = 1) [ 28 ], Japan ( n = 1) [ 25 ], Greece ( n = 1) [ 29 ]. 10 of 13 (77%) studies were conducted before the pandemic.…”

“…The use of non-audited antimicrobials significantly increased after the change in ASP methods ( P < .001), the slope during the postintervention period continued to decline at − 1.87 DOT/1,000-PD per month - The LOT of all systemic antimicrobials declined before the intervention by − 2.30 LOT/1,000-PD per month, and, despite a significant increase in slope ( P = .029), use continued to decrease after the intervention by − 0.33 LOT/1,000-PD per month Moriyama, (2021) [ 25 ] Japan cross-sectional study - Prospective audit and feedback protocol were observed in 23 (59.0%) hospitals when using broad-spectrum antimicrobials - Preauthorization was observed in 4 (10.3%) hospitals for using broad-spectrum antimicrobials.—Notification protocols support form was present in 37 (94.9%) for use of broad-spectrum antimicrobials - The number of hospitals with preauthorization and notification protocols, respectively, using the investigated antibiotics were as follows: broad-spectrum antimicrobials overall 4 (10.3%) and 37 (94.9%); carbapenem 2 (5.1%) and 34 (87.2%); 3rd generation cephalosporin 0 (0%) and 0 (0%); 4th generation cephalosporin 0 (0%) and 10 (25.6%); piperacillin/tazobactam 0 (0%) and 17 (43.6%); and intravenous quinolone 3 (7.7%), and 18 (46.2%) - Regarding preauthorization and notification protocols, there were no significant differences between small/middle-sized hospitals and large hospitals - The numbers for hospitals that had intervention procedures within 7 d and 28 d, respectively, for each investigated antibiotic were as follows: broad-spectrum antimicrobials overall 17 (43.6%) and 34 (87.2%); carbapenem 16 (41.0%) and 34 (87.2%); 3rd generation cephalosporin 1 (2.6%) and 11 (28.2%); 4th generation cephalosporin 7n(17.9%) and 20 (51.3%); piperacillin/tazobactam 12 (30.8%) and 23 (59.0%); and intravenous quinolone 13 (30.8%) and 22 (56.4%). Intervention procedures to use broad-spectrum antimicrobials within 7 d were statistically more frequent in small/middle-sized hospitals than in large hospitals with findings as follows: overall, OR = 5.7, 95% CI = 1.4–23.5, p = 0.023; carbapenem, OR = 4.7, 95% CI = 1.1–19.1, p = 0.049; piperacillin/tazobactam, OR = 7.3, 95% CI = 1.3–39.9, p = 0.018; and intravenous quinolone, OR = 8.8, 95% CI = 1.6–48.2, p = 0.008 Thakkar (2021) [ 26 ] India Prospective study - The pre-existing components of the hospital antimicrobial stewardship program included generation of antibiogram, formulation/ education and dissemination of antibiotic policies for surgical prophylaxis, community and hospital acquired infections and auditing antibiotics for surgical prophylaxis - Prospective audit and feedback for the restricted antimicrobials - Antibiotic restriction using the justification form - Around 1.4% of admitted patients were put on restricted antimicrobials. The total days of therapy (DOT) were 41.5/1000 inpatient days - Unjustified use of antimicrobials was reported in 13% and recommendation of the AMS for de-escalation were accepted in 89% by the treatment team - There was no significant difference between antimicrobial DOT of the restricted...…”

Antimicrobial Resistance: The 'Other' Pandemic!

“…This decision is communicated to the prescriber and a consensual decision is taken to continue or stop the antibiotic. The acceptance of the back end strategy is better though it is more labor intensive [ 45 ].…”

Antimicrobial Stewardship Intervention Before and During The COVID-19 Pandemic in the Acute Care Settings: A Systematic Review

“…Most quantitative studies were retrospective. Only three studies were prospective [1,27,31]. Most of the studies were interventional, whereas three studies were randomised-controlled trials [33,19,34], one study had a before-and-after design [31], another study was observational [16], and two studies were cross-sectional [17,19] (Tables 3, 4).…”

“…The AMS strategies have antibiotic prescribing and reduced antibiotic use. In this review, a range of AMS intervention strategies has been classi ed according to the AMS implementation guidelines of the United States Infectious Disease Society of America (IDSA) and UK Public Health England toolkit into core and supplemental strategies [4, 27,28].…”