Background The inappropriate use of antimicrobials is currently observed in intensive care units (ICUs). Published data has shown that implementation of an antimicrobial stewardship program (ASP) will prevent emergence of antimicrobial resistance. KFSHRC, ICUs in particular, is one setting where monitoring the use of antimicrobials is essential.

Purpose To compare the appropriateness of empirical antibiotic treatment before and after implementation of ‘proactive’ ASP in the medical intensive care unit (MICU).

Materials and methods This was a comparative, non-randomised, historical-controlled study. Adult medical ICU patients were prospectively enrolled in the active ASP arm if they were on five targeted antibiotics and compared with historical patients who were admitted to the same unit before the ASP was used. The primary outcome was the appropriateness of empirical antibiotic treatment before and after implementation of ASP. Secondary outcomes included the rate of clostridium difficile-associated diarrhoea (CDAD), frequency of multi-drug resistant organisms (MDR) and rate of acceptance of recommendation by physicians. It was determined that 73 participants would yield 90% power to detect a difference of 0.20% between groups for the primary outcome.

Results A total of 73 subjects were recruited, 49 as historical controls and 24 in the active arm. ASP implementation resulted in improving the appropriate use of empirical antibiotics from 30.6% (15/49) in the historical control arm to 100% (24/24) in the active ASP arm (P < 0.0001). For the active group, initially 19/24 (79.1%) of the antibiotic use was inappropriate, and this improved with the ASP to 24/24 (100%). A total of 27 interventions were made, with an acceptance rate of 96.3%. A positive effect was noted in the emergence of MDR organisms 15/49 (30.6%) in the historical control arm compared to 2/24 (8.3%) in the active arm (P =.034). The rate of CDAD did not differ between the groups.

Conclusions Implementation of ASP in the ICU can ensure appropriate empirical antibiotic treatment and reduce the emergence of MDR.