Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital

Abstract

BackgroundThe optimal way for antimicrobial stewardship programs (ASPs) to interact with existing infectious disease physician (IDP) services within the same institution is unknown. In our institution, IDPs and our prospective audit and feedback ASP operate independently, with occasionally differing recommendations offered for the same inpatient. We performed a retrospective audit on inpatients that had been reviewed by both IDPs and ASP within a 7-day period, focusing on cases where different therapy-modifying recommendations had been offered. We analyzed the outcomes in inpatients where the ASP recommendations were accepted and compared these with the inpatients where the IDP recommendations were accepted instead. Outcomes assessed were 30-day mortality post-ASP review, unplanned re-admission within 30 days post-discharge from hospital, and clinical deterioration at 7 days post-ASP review.FindingsThere were 143 (18.9%) patients where differing recommendations had been offered, with primary physicians accepting 69.9% of ASP recommendations. No significant differences in terms of demographics, clinical characteristics, 30-day mortality, and re-admission rates were observed, although clinical deterioration rates were lower in patients where the ASP recommendation was accepted (8.0% vs. 27.9%; p = 0.002). On multivariate analysis, hematology-oncology inpatients were associated with unplanned readmission. Increasing age and hematology-oncology inpatients were associated with clinical deterioration 7 days post-recommendation, whereas acceptance of ASP recommendations was protective. No characteristic was independently associated with 30-day mortality.ConclusionIn conclusion, independent reviews by both IDPs and ASPs can be compatible within large tertiary hospitals, providing primary physicians even in situations of conflicting recommendations viable alternative antimicrobial prescribing advice.

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Carbapenem Resistance in Gram-Negative Bacteria: The Not-So-Little Problem in the Little Red Dot

“…In this respect, we can be considered a forerunner in ASP among Southeast Asian countries. In 2011, the government-funded National ASP was implemented in all public hospitals in Singapore [ 48 , 49 , 50 , 51 ]. The hospitals employ a multi-pronged strategy including a prospective audit and feedback approach, formulary restrictions, development of antimicrobial use guidelines, and use of computerized clinical decision support systems [ 48 , 52 , 53 ].…”

The impact of infectious disease specialists on antibiotic prescribing in hospitals

“…First, there can be considerable variability in the antibiotic prescribing practices of IDSs, particularly if they had received training at different institutions, and especially for situations in which evidence‐based recommendations are missing or local antimicrobial guidelines do not exist . In a hospital in Singapore, IDSs and a prospective audit and feedback AMSP operated independently, with different therapy‐modifying recommendations being offered for the same inpatients in 19% (143/756) of the cases . Moreover, conflicts of interest can occur between any prescriber, including the IDSs, and the pharmaceutical industry .…”