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Published on: August 30, 2018
Short-term effects of antimicrobial stewardship programs on antibiotics usage, clinical outcomes, and multidrug
Rania Tarek Helmi1, Juhaina Salim Al-Maqbali2, Sarah Gamal3
1Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman.
Background:
Antimicrobial resistance is associated with increasing mortality rates and the emergence of multidrug-resistant (MDR) organisms. There is scarcity of data on the short-term impact of Antimicrobial Stewardship Programs (ASP) on antibiotic usage, clinical outcome and MDR organisms' pattern following the COVID-19 pandemic. This study evaluated the short-term effects of ASP on antibiotic usage, clinical outcomes and MDR organisms' pattern in the post COVID-19 era.
Methods:
Conducted at a tertiary academic health center, this observational study involved adult patients (≥18 years) in the general medical unit, treated with oral or intravenous antibiotics from May 1, 2021, to April 30, 2022. The applied ASP strategy was a prospective audit and feedback where a weekly meeting was held to discuss the antimicrobial therapy of admitted patient, after which recommendations were made regarding antimicrobial use.
Results:
The study included 301 patients with 166 (55.1%) pre-ASP and 135 (44.9%) post-ASP. The median (IQR) age was 69 (55-77) years with 56.1% were female. Antibiotic usage dropped by 25.2% post-ASP. The length of hospital stay (LOS) was longer post-ASP (7 days vs. 7.9 days, p = 0.001), with MDR infections being a significant predictor (OR: 0.486, p < 0.001). There were no significant differences in 28-day readmission, recurrence of infections and all-cause mortality. Post-ASP, MDR pathogens increased (17.0% vs. 6.6%, p = 0.013), however, after separating post-ASP into two three-months periods, MDROs numbers decreased slightly (13 vs. 10).
Conclusion:
Short-term ASP implementation post COVID-19 reduced antibiotic usage while other clinical outcomes remained unchanged. Nonetheless an increase in MDR pathogens and LOS was observed. Further research is required to assess ASP's long-term impact on MDR infections rates and specific patient group outcomes.
Insights
Antimicrobial Stewardship Programs (ASP) reduced antibiotic use post-COVID-19 but increased multidrug-resistant (MDR) organisms and length of stay. Further research is needed on long-term MDR impacts.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Pharmacy
Background:
- Antimicrobial resistance (AMR) is a growing global health threat, increasing mortality and driving the emergence of multidrug-resistant (MDR) organisms.
- Data on the short-term impact of Antimicrobial Stewardship Programs (ASP) on antibiotic usage, clinical outcomes, and MDR organism patterns post-COVID-19 pandemic is limited.
- This study addresses the scarcity of information by evaluating the immediate effects of ASP implementation in the post-pandemic era.
Purpose of the Study:
- To assess the short-term impact of an Antimicrobial Stewardship Program (ASP) on antibiotic consumption.
- To evaluate the effects of ASP on clinical outcomes, including length of hospital stay (LOS), readmission rates, infection recurrence, and mortality.
- To analyze the changes in the prevalence of multidrug-resistant (MDR) organisms following ASP implementation.
Main Methods:
- An observational study was conducted at a tertiary academic health center involving adult patients treated with antibiotics.
- Data was collected from May 2021 to April 2022, encompassing a pre-ASP and post-ASP period.
- The ASP strategy involved prospective audit and feedback through weekly multidisciplinary meetings to guide antimicrobial therapy.
Main Results:
- A total of 301 patients were included; 166 pre-ASP and 135 post-ASP.
- Antibiotic usage decreased by 25.2% post-ASP implementation.
- While 28-day readmission, infection recurrence, and all-cause mortality remained unchanged, the length of hospital stay (LOS) increased (7 vs. 7.9 days, p=0.001), and the prevalence of MDR pathogens rose (17.0% vs. 6.6%, p=0.013).
Conclusions:
- Short-term ASP implementation effectively reduced antibiotic usage but did not improve other clinical outcomes.
- An increase in MDR pathogens and LOS was observed in the short term post-ASP.
- Further investigation is warranted to understand the long-term effects of ASP on MDR infections and patient outcomes.
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