An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes

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An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes


JournalJournal of Pharmaceutical Policy and Practice
Publication date – Oct – 2020
Authors – Kashif Hussain, Muhammad Faisal Khan, Gul Ambreen, Syed Shamim Raza, Seema Irfan, Kiren Habib, and Hasnain Zafar
KeywordsAntibiotic resistance, Antibiotic stewardship program, Infectious disease pharmacist, Surgical-ICU
Open access – Yes
SpecialityEmergency surgery, General surgery
World region Southern Asia
Country: Pakistan
Language – English
Submitted to the One Surgery Index on November 11, 2020 at 6:42 pm
Abstract:

Background
Antibiotic resistance (ABX-R) is alarming in lower/middle-income countries (LMICs). Nonadherence to antibiotic guidelines and inappropriate prescribing are significant contributing factors to ABX-R. This study determined the clinical and economic impacts of antibiotic stewardship program (ASP) in surgical intensive care units (SICU) of LMIC.

Method
We conducted this pre and post-test analysis in adult SICU of Aga Khan University Hospital, Pakistan, and compared pre-ASP (September–December 2017) and post-ASP data (April–July 2018). January–March 2018 as an implementation/training phase, for designing standard operating procedures and training the team. We enrolled all the patients admitted to adult SICU and prescribed any antibiotic. ASP-team daily reviewed antibiotics prescription for its appropriateness. Through prospective-audit and feedback-mechanism changes were made and recorded. Outcome measures included antibiotic defined daily dose (DDDs)/1000 patient-days, prescription appropriateness, antibiotic duration, readmission, mortality, and cost-effectiveness.

Result
123 and 125 patients were enrolled in pre-ASP and post-ASP periods. DDDs/1000 patient-days of all the antibiotics reduced in the post-ASP period, ceftriaxone, cefazolin, metronidazole, piperacillin/tazobactam, and vancomycin showed statistically significant (p < 0.01) reduction. The duration of all antibiotics use reduced significantly (p < 0.01). Length of SICU stays, mortality, and readmission reduced in the post-ASP period. ID-pharmacist interventions and source-control-documentation were observed in 62% and 50% cases respectively. Guidelines adherence improved significantly (p < 0.01). Net cost saving is 6360US$ yearly, mainly through reduced antibiotics consumption, around US$ 18,000 (PKR 2.8 million) yearly.

Conclusion
ASP implementation with supplemental efforts can improve the appropriateness of antibiotic prescriptions and the optimum duration of use. The approach is cost-effective mainly due to the reduced cost of antibiotics with rational use. Better source-control-documentation may further minimize the ABX-R in SICU.

OSI Number – 20738
PMID – 33042557

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