First Reported Antimicrobial Stewardship Program in a Malaysian District Hospital: First Year Experience

Abstract

Backgrounds & Objective:Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital.Methods:An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above.Results:Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004).Conclusion:ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures.

OneHealth Approaches Contribute Towards Antimicrobial Resistance: Malaysian Perspective

“…The purpose of AMS establishment is to introduce a coordinated systematic approach to improve the appropriate use of antimicrobials by promoting the selection of optimal antimicrobial drug regimen in people such as the right antimicrobial choice, right route of administration, right dose, right time, right duration, and minimize harm to current and future patients. This was particularly true with MOH hospitals where 1 year after the implementation of AMS, a reduction in antibiotic utilization was seen with almost all the common antibiotics and has shown a significant improvement in adherence rate toward antimicrobial authorization policy ( Sing et al, 2016 ).…”

Staphylococcus aureus Infections in Malaysia: A Review of Antimicrobial Resistance and Characteristics of the Clinical Isolates, 1990–2017

“…The second edition of the National Antibiotic Guideline 2014 is in line with the Protocol on Antimicrobial Stewardship (AMS) Program in healthcare facilities launched at the end of 2014 [44]. Overall, the prevalence of resistance to some of these drugs seems to be reduced as the positive outcome of the implementation of the AMS program [45]. The five core strategies of AMS are as follows: (i) Formulation of an AMS team in each hospital, health district office and health clinics; (ii) surveillance and feedback mechanism on specific antimicrobial consumption; (iii) implementation of prospective audit and feedback according to local needs; (iv) formalize regular antimicrobial rounds by AMS team especially in state and specialist hospitals; and (v) establishment of formulary restriction and a pre-authorization/approval system [46].…”

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“…One study finds that the multifaceted interventions implemented following the ASU recommendations are very effective, decreasing prescription rates from 74% to 13% in acute URI and from 78% to 19.1% in acute diarrhoea (15). Malaysia’s MoH has outlined a protocol for an antibiotic stewardship programme (25), but its implementation is only slowly gaining momentum within public hospitals. This study has shown that educating physicians and the public through a multifaceted intervention can reduce antibiotic prescription rates without compromising patient outcome.…”