TY - JOUR
T1 - Impact of antimicrobial stewardship interventions on days of therapy and guideline adherence
T2 - A comparative point-prevalence survey assessment
AU - Shamseddine, Jinan
AU - Sadeq, Ahmed
AU - Yousuf, Khadija
AU - Abukhater, Rawan
AU - Yahya, Lamia Omer
AU - Espil, Maysaa Abdulatif
AU - Hassan, Mohamed Elamin
AU - Fadl, Rayan Elamin
AU - Ahmed, Rami Tag Elsir
AU - Elkonaissi, Islam
AU - Abdelsalam, Abeer Elmahi
AU - Naqbi, Aisha Al
AU - Nuaimi, Nora Al
AU - Hosani, Maitha Al
AU - Marri, Rowdha Al
AU - Abdouli, Asma Al
AU - Alakhras, Abdullah Mohamad
AU - Masri, Neamat Ibrahim Al
AU - O’Sullivan, Siobhan
AU - Everett, Dean
AU - Babiker, Zahir Osman Eltahir
N1 - Publisher Copyright:
Copyright © 2023 Shamseddine, Sadeq, Yousuf, Abukhater, Yahya, Espil, Hassan, Fadl, Ahmed, Elkonaissi, Abdelsalam, Naqbi, Nuaimi, Hosani, Marri, Abdouli, Alakhras, Masri, O’Sullivan, Everett and Babiker.
PY - 2022
Y1 - 2022
N2 - Background: Antimicrobial stewardship (AMS) is a crucial tool for rationalizing the use of antimicrobial agents and reducing the burden of antimicrobial resistance. We aimed to assess the impact of AMS interventions on antimicrobial utilization and adherence to antimicrobial guidelines. Methods: We conducted a prospective quasi-experimental study at a major tertiary hospital in the United Arab Emirates. Using standardized World Health Organization’s methodology, point-prevalence surveys (PPS) were performed in November 2019 and January 2022. Core AMS interventions consisted of proactive bloodstream infection service, proactive and reactive infectious diseases consult service, prospective audit and feedback by clinical pharmacists, development of antimicrobial guidelines based on cumulative antibiograms, and implementation of induction programs for new clinical staff. Days of therapy (DOT) per 1000 patient days present and rate of compliance with antimicrobial guidelines were compared before and after the core interventions. Multiple logistic regression analysis was carried out to adjust for the potential confounding effects of age, gender, hospitalization within 90 days, central or peripheral line insertion, urinary catheterization, and mechanical ventilation. P-value<0.05 was considered statistically significant. Results: Pre- and post-intervention PPSs included 292 and 370 patients, respectively. Both had similar age and gender distribution. Patients receiving antimicrobials were 51% (149/292) in 2019 and 45% (166/370) in 2022 (p 0.12). Univariate analysis showed a reduced post-intervention DOT per 1000 patients present (6.1 +/- 16.2 vs 2.4 +/-5.1, p<0.01) and an improved post-intervention guideline compliance (59% vs 67%, p 0.23). Following multiple logistic regression, the reduction in post-intervention DOT remained statistically significant (co-efficient -0.17 (95% CI -8.58 to -1.94, p<0.01), and the improvement in guideline adherence became statistically significant (adjusted odds ratio 1.91 (95% CI 1.05 to 3.45, p 0.03). Conclusion: Coordinated and sustained AMS interventions have a significant impact on improving antimicrobial utilisation and adherence to guidelines.
AB - Background: Antimicrobial stewardship (AMS) is a crucial tool for rationalizing the use of antimicrobial agents and reducing the burden of antimicrobial resistance. We aimed to assess the impact of AMS interventions on antimicrobial utilization and adherence to antimicrobial guidelines. Methods: We conducted a prospective quasi-experimental study at a major tertiary hospital in the United Arab Emirates. Using standardized World Health Organization’s methodology, point-prevalence surveys (PPS) were performed in November 2019 and January 2022. Core AMS interventions consisted of proactive bloodstream infection service, proactive and reactive infectious diseases consult service, prospective audit and feedback by clinical pharmacists, development of antimicrobial guidelines based on cumulative antibiograms, and implementation of induction programs for new clinical staff. Days of therapy (DOT) per 1000 patient days present and rate of compliance with antimicrobial guidelines were compared before and after the core interventions. Multiple logistic regression analysis was carried out to adjust for the potential confounding effects of age, gender, hospitalization within 90 days, central or peripheral line insertion, urinary catheterization, and mechanical ventilation. P-value<0.05 was considered statistically significant. Results: Pre- and post-intervention PPSs included 292 and 370 patients, respectively. Both had similar age and gender distribution. Patients receiving antimicrobials were 51% (149/292) in 2019 and 45% (166/370) in 2022 (p 0.12). Univariate analysis showed a reduced post-intervention DOT per 1000 patients present (6.1 +/- 16.2 vs 2.4 +/-5.1, p<0.01) and an improved post-intervention guideline compliance (59% vs 67%, p 0.23). Following multiple logistic regression, the reduction in post-intervention DOT remained statistically significant (co-efficient -0.17 (95% CI -8.58 to -1.94, p<0.01), and the improvement in guideline adherence became statistically significant (adjusted odds ratio 1.91 (95% CI 1.05 to 3.45, p 0.03). Conclusion: Coordinated and sustained AMS interventions have a significant impact on improving antimicrobial utilisation and adherence to guidelines.
KW - antimicrobial guidelines
KW - antimicrobial stewardship
KW - antimicrobial stewardship (AMS)
KW - antimicrobial utilization
KW - days of therapy
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U2 - 10.3389/fitd.2022.1050344
DO - 10.3389/fitd.2022.1050344
M3 - Article
AN - SCOPUS:85183623470
SN - 2673-7515
VL - 3
JO - Frontiers in Tropical Diseases
JF - Frontiers in Tropical Diseases
M1 - 1050344
ER -
