Background Antimicrobial stewardship programmes (ASPs) in hospitals are essential in safeguarding the effectiveness and safety of infectious diseases treatment. National legislation often provides the guidelines for development of such programmes, but their implementation relies on the perseverance and the communication skills of the members of the hospital Infectious Diseases Committee (IDC).
Purpose To evaluate the impact of an intervention that was designed to survey, audit and optimise the administration of colistin, daptomycin and tigecyclIne in a tertiary general hospital, as an additional measure in the already implemented hospital ASP.
Material and methods Medication review of all prescribed antimicrobials was performed at the hospital pharmacy (HP), for 6 months in 2017. Documentation on the administration of the three antimicrobials was requested and if not provided, an IDC member was assigned to audit the patient case and recommend appropriate adjustments. Data on prescriptions and consumption of antimicrobials in daily defined doses per 100 beddays (DDDs/100bd), IDC recommendations and patient outcomes (mortality and length of stay) were collected and analysed by Excel® and SPSS®.
Results An average of 750 prescriptions per week was reviewed at the HP and about 10% of them included the antimicrobials under surveillance. Documentation was provided for 12% of these prescriptions, whereas audit was feasible on 50% of the undocumented ones. Treatment optimisation, based on consequent IDC recommendations, was observed in 9% of the audited patient cases. In 39% of the patient cases under surveillance, the antimicrobials were administered in combination and in 15% of them, all three were administered. In total, the hospital consumption of colistin, daptomycin and tigecycline was respectively 7.8 DDDs/100bd, 3.3 DDDs/100bd and 4.2 DDDs/100bd, decreased by an average of 1.5%, compared to those of the first semester of 2016. Length of stay and mortality rates among audited, optimised for treatment cases remained unaffected by the intervention, although data need further analysis.
Conclusion The persuasion of clinicians to prescribe antimicrobials according to guidelines and recommendations often fails, as they usually rely on their clinical expertise to make relevant decisions. Although this ASP intervention had influenced antimicrobial consumption, it did not significantly impact patient outcomes. The intervention is further evaluated for cost-effectiveness and patient readmission events.
No conflict of interest
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