Impact of Multidisciplinary Team Escalating Approach on Antibiotic Stewardship in the United Arab Emirates

Abstract

Antimicrobial stewardship programs (ASP) are an essential strategy to combat antimicrobial resistance. This study aimed to measure the impact of an ASP multidisciplinary team (MDT) escalating intervention on improvement of clinical, microbiological, and other measured outcomes in hospitalised adult patients from medical, intensive care, and burns units. The escalating intervention reviewed the patients’ cases in the intervention group through the clinical pharmacists in the wards and escalated complex cases to ID clinical pharmacist and ID physicians when needed, while only special cases required direct infectious disease (ID) physicians review. Both non-intervention and intervention groups were each followed up for six months. The study involved a total of 3000 patients, with 1340 (45%) representing the intervention group who received a total of 5669 interventions. In the intervention group, a significant reduction in length of hospital stay (p < 0.01), readmission (p < 0.01), and mortality rates (p < 0.01) was observed. Antibiotic use of the WHO AWaRe Reserve group decreased in the intervention group (relative rate change = 0.88). Intravenous to oral antibiotic ratio in the medical ward decreased from 4.8 to 4.1. The presented ASP MDT intervention, utilizing an escalating approach, successfully improved several clinical and other measured outcomes, demonstrating the significant contribution of clinical pharmacists atimproving antibiotic use and informing antimicrobial stewardship.

Experience of Vancomycin Therapeutic Drug Monitoring in Two Multidisciplinary Hospitals in Latvia

“…At 30 days after initiation of vancomycin therapy in the intervention group (vancomycin dosing protocol, guided by a pharmacist) resulted in significantly higher survival rate compared to the non-intervention group (82.1% vs. 53.1%) [ 37 ]. Such results confirm how important is the process of appropriate vancomycin dosing and TDM practices, preferably lead by a clinical pharmacist as an important a member of a multidisciplinary antimicrobial management team in a hospital [ 43 ].…”

Pharmacists’ Knowledge, Attitudes, Behaviors and Information Sources on Antibiotic Use and Resistance in Jordan

“…Antimicrobial stewardship should include a team of multidisciplinary healthcare professionals and is implemented to varying degrees in different countries [ 12 , 13 ]. Antimicrobial stewardship (AMS) has become an important emerging professional role for pharmacists [ 14 , 15 ]. Pharmacists can be involved at different stages in AMS, including patient evaluation, choice of antimicrobial, dispensing, and patient monitoring [ 14 , 15 ].…”

“…Antimicrobial stewardship (AMS) has become an important emerging professional role for pharmacists [ 14 , 15 ]. Pharmacists can be involved at different stages in AMS, including patient evaluation, choice of antimicrobial, dispensing, and patient monitoring [ 14 , 15 ]. Antimicrobial stewardship has been shown to address the issue of AMR and promote the prudent use of antimicrobials and associated infection control strategies [ 16 , 17 ].…”

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

“…The included studies have been classified into four groups: 13 articles involved IP settings without a pharmacist as a part of an AMS-MDT intervention [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], 19 were carried out in IP settings with the inclusion of a pharmacist as a part of the intervention team [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], eight articles engaged OP without a pharmacist [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], while eight involved OP settings with a pharmacist [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Forty-one articles were from d...…”

“…Of those, seven scored high risk [ 33 , 34 , 46 , 57 , 59 , 63 , 67 ], three scored low risk [ 28 , 32 , 60 ], with one article only found to have some concerns [ 58 ]. On the other hand, the remaining 37 articles were non-randomized before and after methodology and were assessed using the ROBINS-1 assessment tool [ 24 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ]. Out of those 37, 29 were at moderate risk of bias [ 24 , ...…”