An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes
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...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2020-12-01
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| Series: | Journal of Pharmaceutical Policy and Practice |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1186/s40545-020-00272-w |
| _version_ | 1797401316348133376 |
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| author | Kashif Hussain Muhammad Faisal Khan Gul Ambreen Syed Shamim Raza Seema Irfan Kiren Habib Hasnain Zafar |
| author_facet | Kashif Hussain Muhammad Faisal Khan Gul Ambreen Syed Shamim Raza Seema Irfan Kiren Habib Hasnain Zafar |
| author_sort | Kashif Hussain |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-09T02:08:20Z |
| format | Article |
| id | doaj.art-f39a20dc505349faa534fd363f45210b |
| institution | Directory Open Access Journal |
| issn | 2052-3211 |
| language | English |
| last_indexed | 2024-03-09T02:08:20Z |
| publishDate | 2020-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Pharmaceutical Policy and Practice |
| spelling | doaj.art-f39a20dc505349faa534fd363f45210b2023-12-07T15:28:03ZengTaylor & Francis GroupJournal of Pharmaceutical Policy and Practice2052-32112020-12-0113110.1186/s40545-020-00272-w12315193An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomesKashif Hussain0Muhammad Faisal Khan1Gul Ambreen2Syed Shamim Raza3Seema Irfan4Kiren Habib5Hasnain Zafar6Department of Pharmacy,Department of Anesthesia,Department of Pharmacy,Department of Pharmacy,Section of Microbiology,Department of Internal Medicine (Infectious Disease),Department of Surgery,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.http://dx.doi.org/10.1186/s40545-020-00272-wantibiotic stewardship programantibiotic resistanceinfectious disease pharmacistsurgical-icu |
| spellingShingle | Kashif Hussain Muhammad Faisal Khan Gul Ambreen Syed Shamim Raza Seema Irfan Kiren Habib Hasnain Zafar An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes Journal of Pharmaceutical Policy and Practice antibiotic stewardship program antibiotic resistance infectious disease pharmacist surgical-icu |
| title | An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes |
| title_full | An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes |
| title_fullStr | An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes |
| title_full_unstemmed | An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes |
| title_short | An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes |
| title_sort | antibiotic stewardship program in a surgical icu of a resource limited country financial impact with improved clinical outcomes |
| topic | antibiotic stewardship program antibiotic resistance infectious disease pharmacist surgical-icu |
| url | http://dx.doi.org/10.1186/s40545-020-00272-w |
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