The Impact of a Post-Prescription Review and Feedback Antimicrobial Stewardship Program in Lebanon

Abstract

Antimicrobial stewardship programs (ASPs) are effective means to optimize prescribing practices. They are under-utilized in the Middle East where many challenges exist for ASP implementation. We assessed the effectiveness of infectious disease physician-driven post-prescription review and feedback as an ASP in Lebanon. This prospective cohort study was conducted over an 18-month period in the medical, surgical, and intensive care units of a tertiary care hospital. It consisted of three phases: the baseline, intervention, and follow-up. There was a washout period of two months between each phase. Patients aged ≥16 years receiving 48 h of antibiotics were included. During the intervention phase, the AMS team reviewed antimicrobial use within 72 h post-prescription and gave alternate recommendations based on the guidelines for use. The acceptance of the recommendations was measured at 72 h. The primary outcome of the study was days of therapy per 1000 study patient days. A total of 328 patients were recruited in the baseline phase (August–October 2020), 467 patients in the intervention phase (January–June 2021), and 301 patients in the post-intervention phase (September–December 2021). The total days of therapy decreased from 11.46 during the baseline phase to 8.64 during the intervention phase (p < 0.001). Intervention acceptance occurred 88.5% of the time. The infectious disease physician-driven implementation of an ASP was successful in reducing antibiotic utilization in an acute care setting in Lebanon.

Tailoring Antimicrobial Stewardship (AMS) Interventions to the Cultural Context: An Investigation of AMS Programs Operating in Northern Italian Acute-Care Hospitals

“…Results of several studies suggest post-prescription review and feedback AMS programs are effective in both HICs and LMICs [ 5 , 12 ], and could be more acceptable than restrictive strategies [ 20 ]. For the purpose of this study, we conducted further analyses on data collected through our previous study, with the objective of determining if enabling and restrictive AMS strategies operating in our context were associated with different outcomes in terms total antimicrobial usage, MRSA and CRE rates.…”

“…A recent study by Shallal et al published in Antibiotics evaluated the impact of a post-prescription review and feedback AMS program operating in a tertiary-care hospital in Lebanon [ 12 ]. The authors found the intervention engaged physicians in discussions, provided a platform for education, and fostered collaborative decision-making concerning antibiotic prescription.…”

“…Interdisciplinary and multifaceted approaches have been identified as important elements for AMS intervention success [ 9 , 13 ]. Furthermore, the study by Shallal et al included a survey of physicians’ attitudes towards the program, which revealed a high level of acceptability of the program (88%) and interesting cultural considerations, including the importance of continuous education, of placing infectious disease specialists rather than pharmacists in AMS leadership roles, and of locally developed guidelines [ 12 ]. A previous systematic review of studies conducted in the Middle East highlighted the impact of cultural elements such as physician attitudes and acceptance of collaborative practices on the effectiveness of AMS interventions [ 14 ].…”

Risk factors for healthcare-associated infections and antimicrobial use: indicators from a national dataset

“…Among the variables monitored by the PPS-2 study and related to the hospital's structure, personnel and organization of IPC activities, we selected the ones potentially acting as determinants of the aforementioned outcomes [11]. A review of the available literature led to considering the following candidate determinants: percentage of single-bed rooms [12][13][14][15], percentage of airborne-infection isolation rooms [13,16], annual alcohol-based hand rub (ABHR) consumption [17,18], proportion of healthcare workers bringing the ABHR dispenser [19] (dichotomized into ≤ 25% vs > 25% as per the multiple choices provided by the PPS-2 form), number of blood cultures per 100 beds [20], number of fulltime equivalent (FTE) nurses [21][22][23], IPC physicians [24][25][26] and antibiotic consultants per 100 beds [27], routine production of an IPC plan [28] and an IPC report [6,7], number of HAI surveillances [29][30][31] and of HAI prevention measures [32], presence of antimicrobial stewardship programmes [24,33] and routine performance of a post-prescription review of antibiotic therapies [34,35]. Data for all these determinants were retrieved from the hospital-level questionnaire form of the PPS-2, except for the proportion of single-bed rooms and ABHR consumption, which were based on data provided through the ward-level forms.…”

Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications

“…We are now seeing a growth in antimicrobial stewardship programs (ASPs) in hospitals across countries and continents to address concerns with inappropriate prescribing [63,69,70]. These include addressing concerns with extended prophylaxis beyond the first day to prevent SSIs and reducing excessive prescribing of antibiotics generally within hospitals [63,69,71,72].…”