Impact of antimicrobial stewardship on antibiogram, consumption and incidence of multi drug resistance

Abstract

Introduction Antimicrobial stewardship programs are intended to improve patient outcomes, reduce side effects, bacterial resistance, and costs. Thus, it is important to assess their impact on an ongoing basis. We aimed to assess the impact of the antimicrobial stewardship program in two different hospitals which used different program approaches. Methodology This is a retrospective observational study in two private hospitals [4088 patient records] in Amman- Jordan. Antibiotic susceptibility using antibiogram results, consumption of antibiotics using Defined Daily Dose, and the incidence of Multi-Drug Resistance were recorded using patients’ records during 2018, 2019, and 2020. Results Antimicrobial stewardship program outcomes varied between the two hospitals. Bacterial susceptibility to antibiotics were improved in both hospitals. Moreover, the defined daily dose in Hospital “A” showed no significant change in Fluoroquinolones, Carbapenems, and Piperacillin- Tazobactam, Cephalosporins, and Colistin, while a significant change was observed among Anti-MRSA antibiotics. Finally, the incidence of Extended Spectrum Beta-lactamase [ESBL] E. coli, ESBL Klebsiella, and Vancomycin Resistant Enterococci [VRE] have decreased numerically over the study period, while Methicillin-Resistant Staphylococcus aureus [MRSA] showed an increase in incidence during the second year of the study. Conclusion The study emphasizes the positive impact of the AMS program throughout the three years of the study. Plus, the need to enhance the program through recruiting extra staff and applying extra regulations like implementing educational programs for the hospital staff, designing local guidelines for common ID diseases, and monitoring the program’s outcomes which would eventually be more efficient, cost-effective, and safe.

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

“…Most studies (79%, 42/53) primarily documented a decrease in antibiotic consumption and an improvement in rational antibiotic use after ASP implementation in hospitals [ 39 , 46 , 62 , 64 , 66 – 69 , 71 , 73 , 76 – 104 ]. Metrics for evaluating antibiotic consumption included defined daily doses (DDDs) or days of therapy (DOT) per 1,000 patient-days [ 62 – 64 , 68 , 72 , 77 , 79 – 81 , 84 – 86 , 88 , 100 , 104 , 105 ] while some studies used defined daily doses (DDDs) per 100 patient-days or Days of therapy/DOT per 100 patient-days [ 66 , 67 , 76 , 90 , 97 , 102 ].…”

Increased Incidence and Risk Factors of Infections by Extended-Spectrum β-Lactamase-Producing Enterobacterales During the COVID-19 Pandemic: A Retrospective Case-Control Study

“…24 Therefore, inappropriate use of antimicrobial drugs may also have contributed to the increased incidence of ESBL-E infections during the COVID-19 epidemic. 25 Using multivariate regression analysis, our study showed that a length of hospitalization ≥ 15 days, having chronic kidney disease, using hormonal drugs or ≥ 1 type of antibacterial drugs, and WBC > 9.5×10^9/L were independent risk factors for ESBL-E infection, whereas COPD was a protective factor. Our study found that COVID-19 is not an independent risk factor for ESBL-E infection.…”

Assessing the quality of antimicrobial prescribing in solid organ transplant recipients: a new frontier in antimicrobial stewardship

“…Under the auspices of quality improvement, evaluating adherence to such guidelines can confirm their validity, in addition to informing knowledge translation and implementation strategies. SOTR are disproportionately burdened by antimicrobial resistance, antimicrobial-related adverse events, and healthcare-associated infections 30 , 31 . Local guidelines addressing their unique antimicrobial needs may facilitate appropriate prescribing practices.…”