Evaluating the effects of antimicrobial stewardship program on antimicrobial consumption and resistance patterns: a...

Antimicrobial stewardship programs (ASPs) are coordinated efforts designed to promote the judicious use of antimicrobials, decrease microbial resistance, reduce the spread of multidrug-resistant infections, and improve patient outcomes. This study aimed to evaluate the impact of an ASP on antimicrobial consumption and antimicrobial resistance in a tertiary cardiac centre in Egypt.

A quasi-experimental study was conducted in the adult critical care unit of Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt to assess the changes in antimicrobial consumption and resistance patterns before and after ASP implementation. All patients admitted to the adult critical care area from July 2023 to 30 June 2024 were included in the study.

A total of 1000 patients were included in the pre-intervention period and 982 in the post-intervention period. Following ASP implementation, overall antimicrobial consumption decreased by 23% (from 14,414 to 11,012 DDDs per 1,000 patient days), although this was not statistically significant (p = 0.097). Colistin use declined significantly (817 to 53 DDDs per 1,000 patient days; p = 0.006). Infections caused by Klebsiella pneumoniae decreased significantly (42 to 19 isolates; p = 0.004). Among Enterobacteriaceae, Escherichia coli showed improved susceptibility to gentamicin (36% to 86%; p = 0.01) and meropenem (64% to 100%; p = 0.02). Reductions in fungal infections and improvements in antifungal susceptibility were observed, but were not statistically significant. The number of documented fungal infections decreased from 12 pre-intervention (9 Candida spp. 3 Cryptococcus spp.) to 6 post-intervention (4 Candida spp. 2 Cryptococcus spp.) (p = 0.236). Infections caused by Staphylococcus spp. also decreased slightly with improved susceptibility patterns (p = 0.683).

The implementation of an ASP in the critical care unit was associated with reductions in antibiotic consumption and trends toward decreased antimicrobial resistance, highlighting its potential value in addressing the challenges of antimicrobial misuse and resistance in resource-limited settings.

Not applicable.