Clinical impact of non-antibiotic recommendations by a multi-disciplinary antimicrobial stewardship team

Ng, Tat Ming; Phang, Vanessa Y.; Young, Barnaby Edward; Tan, Si Hui; Tay, Hui Lin; Tan, Michelle W.; L, Li; Ang, Brenda; Teng, Christine B; Lye, David C.

doi:10.1016/j.ijantimicag.2017.01.046

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…These measures were augmented by computerised clinical decision support systems (introduced in 2011) and educational efforts to engage healthcare providers and the public on appropriate use of antimicrobials. [11][12][13] Results of the PPS were shared with the hospital management and senior doctors to raise awareness on the high prevalence of antimicrobial prescribing. These activities may have driven the improvement in some antimicrobial prescribing quality indicators and reduced the prevalence of antimicrobials among acute inpatients.…”

Section: Discussionmentioning

confidence: 99%

Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Antimicrobial Prevalence and Prescribing in a Tertiary Hospital in Singapore

Tan

Heng

et al. 2020

Preprint

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Background: The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing and resistance.Methods: One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017-2019.Results: The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p =0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p <0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p =0.08). Conclusion: AMS efforts over the years paid dividends during the COVID-19 pandemic to sustain the control of antimicrobial prevalence and quality of AMU in non-COVID-19 wards and plausibly also in COVID-19 wards.

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Section: Discussionmentioning

confidence: 99%

Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Antimicrobial Prevalence and Prescribing in a Tertiary Hospital in Singapore

Tan

Heng

et al. 2020

Preprint

Self Cite

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“…(56)(57)(58)(59)(60) Acceptance of ASP recommendations was associated with shorter lengths of stay, decreases in mortality and re-admissions, and substantial cost savings for patients, although ASPs on their own were notably unsuccessful in significantly decreasing the incidence of AMR in local hospitals. (73)(74)(75) The first local CDSS, ARUS-C (Antibiotic Resistance Utilisation and Surveillance-Control), was developed by Tan Tock Seng Hospital in 2009, prior to MOH's ASP fundingwhich spurred attempts to adopt ARUS-C or develop new CDSSs after 2011. (76) By using appropriate algorithms, CDSSs could potentially provide patient-specific, evidence-based antibiotic recommendations at the point of prescribing, an advantage that is potentially magnified by the availability of other patient data within electronic medical records such as drug allergies, culture results, and renal and/or liver function.…”

Section: Hospital Antibiotic Prescriptionmentioning

confidence: 99%

Ten-year narrative review on antimicrobial resistance in Singapore

Chua¹,

Kwa²,

Tan³

et al. 2019

smedj

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Antimicrobial resistance (AMR) results in drug-resistant infections that are harder to treat, subsequently leading to increased morbidity and mortality. In 2008, we reviewed the problem of AMR in Singapore, limiting our discussion to the human healthcare sector. Ten years later, we revisit this issue again, reviewing current efforts to contain it in order to understand the progress made as well as current and emerging challenges. Although a significant amount of work has been done to control AMR and improve antibiotic prescribing in Singapore, most of it has focused on the hospital setting, with mixed impact. The role of antibiotic use and AMR in food animals and the environment-and the link to human health-is better understood today. This issue of AMR encompasses both human health as well as animal/food safety, and efforts to control it will need to continually evolve to maintain or improve on current gains.

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“…The study found that the patient group in which the doctor accepted the clinical recommendations had a significantly lower 30-day mortality rate than the group in which the doctor did not follow the recommendations. This could be due to the enhanced effort for appropriate antimicrobial prescription according to the patient’s condition in addition to antimicrobial restriction during the implementation of the program [ 158 ].…”

Section: Recommended Guidelines For Each Key Questionmentioning

confidence: 99%

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

et al. 2021

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These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.

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Clinical impact of non-antibiotic recommendations by a multi-disciplinary antimicrobial stewardship team

Cited by 10 publications

References 24 publications

Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Antimicrobial Prevalence and Prescribing in a Tertiary Hospital in Singapore

Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Antimicrobial Prevalence and Prescribing in a Tertiary Hospital in Singapore

Ten-year narrative review on antimicrobial resistance in Singapore

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

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