Title : Impact of an Antibiotic Stewardship Program ( ASP) on antibiotic use, bacterial susceptibilities, and cost of antibiotics: A quasi-experimental study from a developing country
Abstract:
Antimicrobial misuse is a worldwide issue, and antimicrobial resistance is considered one of the most challenging aspects of health care. It has been reported that as much as 30%–50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate. Antibiotic stewardship programs (ASPs) include policies that apply continuous management of judicious anti-infectious treatment in the clinical setting. The objectives of this study were to evaluate the effect of ASPs on antibiotic consumption, the costs of antibiotic expenditure, and the sensitivity of antimicrobials.
A retrospective, quasi-experimental study was performed to assess the effect of the ASP at An-Najah National University Hospital, a tertiary care hospital in the West Bank, occupied Palestinian territory, over a period of 20 months before and 17 months after the implementation of the ASP. Data on antibiotic consumption were reported monthly as days of therapy per 1000 patient days and as costs (US$/1000 patient days). As we used retrospective data, the institutional review board of An-Najah National University waived the requirement for informed consent.
Data from medical records of 2367 patients who received one or more of the targeted antibiotics (meropenem, colistin, and tigecycline) during their hospital stay were included in the study. The records were split into two groups: a pre-ASP group, comprising records from 1710 patients, and a post-ASP group, comprising records from 657 patients. The most substantial and statistically significant reduction in days of therapy per 1000 patient days was seen with tigecycline (62·1%, p<0·001), followed by colistin (59·5%, p<0·001), and meropenem (36·7%, p<0·018). The overall cost of the three antibiotics decreased by 55.5%, from the pre-ASP phase to the post-ASP phase. The highest cost saved was with regards to tigecycline consumption (− 62.07%, p<0·001), followed by colistin ( − 59.46%, < 0.001) then meropenem (− 36.68%, p<0.026). After the implementation of the ASP, the susceptibility of Pseudomonas aeruginosa to meropenem (p<0·001). Changes in mortality rates were not statistically significant (p=0·057).
The ASP reduced costs and antimicrobial consumption, but with no statistically significant effect on the overall mortality rate. However, changes in the susceptibility of the pathogens to different antibiotics could not be attributed solely to restrictions of antibiotic use. Therefore, long-term evaluation of the impact of the ASP is needed to conclude its long-term effects on infection-related mortality and antimicrobial susceptibility.
Audience take away:
- The possibility of implementing ASP even in low income countries with limited resources
- Possibility of collaboration with other institutions in terms of research targeting infectious disease and antimicrobial resistance
- Collaboration with others to find opportunities of improving the ASPs interventions
- The elaborate the techniques used to implement and sustain this ASP in our academic center
- Opportunities for improving projects in the aspect of multidrug resistant pathogens and infectious disease
