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Implementation of an antimicrobial stewardship program in Alexandria University Children's Hospital: an
Sarah Elsayed Saad Refaei1, Laila El-Attar2, Amira Ezzat Khamis Amine2
1Alexandria University Children's Hospital, Alexanderia, Egypt.
Insights
Antimicrobial Stewardship Programs (ASPs) improved antibiotic use in a children's hospital. Implementing guidelines and audits reduced hospital stays and costs, combating antimicrobial resistance.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacy
- Public Health
Background:
- Antimicrobial resistance (AMR) is a global health threat, reducing antibiotic effectiveness and increasing mortality.
- Antimicrobial Stewardship Programs (ASPs) are crucial for controlling resistant pathogens.
Purpose of the Study:
- To evaluate the impact of an ASP on antibiotic use and patient outcomes at Alexandria University Children's Hospital.
- To assess adherence to tailored antibiotic guidelines and changes in antibiotic consumption.
Main Methods:
- A nine-month study in a pediatric ward, comparing pre- and post-intervention phases.
- Development of antibiotic guidelines based on medical records and microbiology reports.
- Prospective audits and physician education as key ASP interventions.
Main Results:
- Post-ASP implementation, single antibiotic use increased (69.6% vs. 26%).
- Mean length of hospital stay decreased (10.80 vs. 12.89 days).
- Antibiotic expenditure and days of therapy (DOT) per 1000 patients significantly reduced.
Conclusions:
- Institutional guidelines combined with Prospective Audit and Feedback (PAF) improved antibiotic utilization.
- ASP implementation demonstrated positive outcomes, especially in resource-limited settings.
Background:
Antimicrobial resistance (AMR) represents a threat to global public health. The antibiotics' effectiveness against a variety of infections consequently has been declined with increasing morbidity, mortality, and treatment failure. To combat this, the implementation of Antimicrobial Stewardship Programs (ASPs) is essential for slowing the spread of resistant pathogens.
Aim Of The Work:
The current study aimed to assess the outcomes following implementation of Antimicrobial Stewardship Program (ASP) at Alexandria University Children's Hospital.
Method:
The study was conducted over nine months in a general pediatric ward. First, the medical records and microbiological reports were reviewed to establish tailored antibiotic guidelines. During the intervention phase, the ASP focused on prospective audits and physicians' education. The program's impact was evaluated through several key metrics: adherence to the guidelines, patient outcome (mortality rate and length of stay) and antibiotic consumption (expenditure, days of therapy, and treatment duration). All statistical analyses were conducted using IBM SPSS version 20.0.
Results:
219 patients in the preintervention phase were compared to 214 patients (post-intervention). Following ASP, the use of single antibiotics increased in post-intervention (69.6% versus 26%). During the study period, 70 interventions were required with a high acceptance rate (59%). The mean length of hospital stays decreased [10.80 (3-26) versus 12.89 (4-33) days], and both DOT/1000 patients and the average cost of antibiotics decreased (27.82% and 44.94%, respectively). Following ASP, the use of Tigecycline (-100%), Meropenem (-57.79%), and Vancomycin (-46.35%) reduced with an increase in the use of Cefotaxime (80.43%), Ceftriaxone (20.27%), and Ceftazidime (62.87%).
Conclusion:
The implementation of institutional guidelines along with Prospective Audit and Feedback (PAF) was associated with improvements in antibiotic utilization, particularly in the resource-limited settings.
Clinical Trial Number:
Not applicable.
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