Sustaining Antimicrobial Stewardship in a High–Antibiotic Resistance Setting

Ng, Tat Ming; Heng, Shi Thong; Chua, Boon Hou; Ang, Li Wei; Tan, Si Hui; Tay, Hui Lin; Yap, Min Yi; Quek, Jason; Teng, Christine B; Young, Barnaby Edward; Lin, Ray Jh; Ang, Brenda; Lee, Tau Hong; Lye, David Chien

doi:10.1001/jamanetworkopen.2022.10180

Cited by 4 publications

(2 citation statements)

References 32 publications

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“…9 Another recent study from Singapore found that an intensive antimicrobial stewardship program employing prospective review and computerized decision support systems was associated with limiting the use of pipercillin-tazobactam and carbapenems while reducing use of other antibiotics as well. 10 Our findings suggest opportunities for further de-escalation that can occur based on quantitative assessments of antibiotic spectrum, especially for patients with bacteria-culture-negative HAP and VAP.…”

Section: Discussionmentioning

confidence: 75%

Lack of pathogen identification influencing antibiotic de-escalation in hospital-acquired pneumonia

Bittmann

Micek

Kollef

2022

ASHE

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Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection, representing ∼22% of all hospitalacquired infections. 1 Also, antibiotic resistance is a growing concern throughout healthcare. 2,3 Studies on de-escalation of antibiotic therapy in HAP have shown outcomes to be no worse for patients who had antibiotics de-escalated compared with those who did not. [4][5][6] Therefore, it is prudent to further characterize existing rates of antibiotic de-escalation among HAP patients. In this study, we sought to determine whether any systematic differences in de-escalation patterns exist between 4 pathogen groups (ie, Enterobacterales, Staphylococcus aureus, Pseudomonas aeruginosa, and bacteria-culture-negative status) in patients with HAP and ventilator-acquired pneumonia (VAP) pneumonia.

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Section: Discussionmentioning

confidence: 75%

Lack of pathogen identification influencing antibiotic de-escalation in hospital-acquired pneumonia

Bittmann

Micek

Kollef

2022

ASHE

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“…The decrease in utilisation of quinolones and anti-pseudomonal antibiotics occurred before the decrease in incidence density of C. difficile . In a local study, utilisation rate of broad-spectrum antibiotics had a significant negative correlation with incidence density of C. difficile and carbapenem-resistant P. aeruginosa but not with carbapenem-resistant A. baumannii [ 21 ]. The significant decreases in incidence density of MRSA and carbapenem-resistant and MDR A .…”

Section: Discussionmentioning

confidence: 99%

Antibiotic utilisation and resistance over the first decade of nationally funded antimicrobial stewardship programmes in Singapore acute-care hospitals

Ng,

Ang,

Heng

et al. 2023

Antimicrob Resist Infect Control

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Objective The aim of this study was to describe the time series of broad-spectrum antibiotic utilisation and incidence of antibiotic-resistant organisms during the implementation of antimicrobial stewardship programmes (ASP) in Singapore. Methods An observational study was conducted using data from 2011 to 2020 in seven acute-care public hospitals. We applied joinpoint regressions to investigate changes in antibiotic utilisation rate and incidence density of antibiotic-resistant organisms. Results Across the seven hospitals, quarterly broad-spectrum antibiotic utilisation rate remained stable. Half-yearly incidence density of antibiotic-resistant organisms with two joinpoints at first half (H1) of 2012 and second half (H2) of 2014 decreased significantly in the second and third period with a half-yearly percentage change (HPC) of -2.9% and − 0.5%, respectively. Across the five hospitals with complete data, half-yearly broad-spectrum antibiotic utilisation rate with one joinpoint decreased significantly from H1 of 2011 to H2 of 2018 (HPC − 4.0%) and H2 of 2018 to H2 2020 (HPC − 0.5%). Incidence density of antibiotic-resistant organisms decreased significantly in the two joinpoint periods from H1 of 2012 to H2 of 2014 (HPC − 2.7%) and H2 of 2014 to H2 of 2020 (HPC − 1.0%). Ceftriaxone with one joinpoint decreased significantly from H1 of 2011 to H1 of 2014 (HPC − 6.0%) and H1 of 2014 to H2 of 2020 (HPC − 1.8%) and ceftriaxone-resistant E. coli and K. pneumoniae decreased significantly in later periods, from H2 of 2016 to H2 of 2020 (HPC − 2.5%) and H1 of 2012 to H2 of 2015 (HPC − 4.6%) respectively. Anti-pseudomonal antibiotics with one joinpoint decreased significantly from H1 of 2011 to H2 of 2014 (HPC − 4.5%) and H2 of 2014 to H2 of 2020 (HPC − 0.8%) and that of quinolones with one joinpoint at H1 of 2015 decreased significantly in the first period. C. difficile with one joinpoint increased significantly from H1 of 2011 to H1 of 2015 (HPC 3.9%) and decreased significantly from H1 of 2015 to H2 of 2020 (HPC − 4.9%). Conclusions In the five hospitals with complete data, decrease in broad-spectrum antibiotic utilisation rate was followed by decrease in incidence density of antibiotic-resistant organisms. ASP should continue to be nationally funded as a key measure to combat antimicrobial resistance in acute care hospitals.

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