Implementation of a Program for Optimizing the Use of Antimicrobials: Outcomes After Six Months of Activity

Antimicrobial resistance threatens global health, mainly due to the irrational and excessive use of antibiotics. Antimicrobial stewardship programs (ASPs) have emerged as a leading strategy in healthcare institutions, aiming for:

·        Optimized antimicrobial use and dosage

·        Improved patient treatment outcomes

·        Reduced adverse effects and healthcare costs

·        Lower AMR rates^[1][2][3]

 

ASP implementation typically involves pharmacist or infectious disease specialist-led multidisciplinary teams, protocols for antibiotic prescribing, regular audit and feedback, education, and monitoring of process/outcome metrics.

Program Design and Setting

A multidisciplinary stewardship team initiated the ASP, including the following interventions:

·        Formulation of evidence-based empirical antibiotic guidelines

·        Educational sessions for prescribers

·        Daily review and feedback for ongoing prescriptions

·        Mandated documentation for indication and planned duration

·        Enhanced laboratory reporting for targeted de-escalation

 

Data Collection and Analysis

Pre-implementation data were collected for six months, followed by six months of post-implementation monitoring. The following metrics were assessed:

·        Antimicrobial consumption (defined daily doses, DDD per 1,000 patient-days)

·        Adherence to prescribing policy and rates of guideline-concordant use

·        Antimicrobial de-escalation frequency

·        Days of therapy (DOT) per 1,000 patient-days

·        Indicators of AMR and pathogen susceptibility patterns

·        Patient outcomes: length of stay (LOS), 30-day readmission, mortality rates

·        Cost analysis: antimicrobial expenditure pre- and post-intervention

 

Statistical comparisons were conducted using chi-square and t-tests, with significance set at p<0.05.

1. Antimicrobial Utilization

·        Total antimicrobial DDD decreased by 6–16% after six months of ASP activity^[2][4][5].

·        The mean stewardship-focused antibiotic utilization dropped from 510.3 to 426.4 DDD/1,000 patient days (16.4% reduction, p<.001)^[4].

·        Broad-spectrum and anti-pseudomonal antibiotic usage showed the most notable declines.

 

Table 1: Antibiotic Usage Before and After ASP (per 1,000 patient days)

 

2. Adherence to Prescribing Policy

·        Policy adherence improved from 23.7% to 41.8% after ASP implementation^[2].

·        More prescriptions documented indication, duration, and appropriate culture sampling before initiation (from 36.7% to 60.4% of cases).

3. De-escalation Rates

·        De-escalation (modification to more targeted therapy) increased from 22.7% to 43.5% post-ASP^[2].

1.      Kamphuis, Bregtje, et al. “Access to Medicines in Europe: Delays and Challenges for Access.” London School of Economics, 2021.

2.      Chang, Y.Y., et al. "Implementation and outcomes of an antimicrobial stewardship program." ScienceDirect, 2017.

3.      Chowdhury, S.S., et al. "The impact of antimicrobial stewardship programme on hospital antibiotic use and adherence." PubMed, 2020.

4.      Wilcox, Mark H., et al. "Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection." New England Journal of Medicine, vol. 376, no. 4, 2017, pp. 305–317.

5.      Shah, N., et al. "Impact of Antibiotic Stewardship Program on Prescribing Practices." PMC, 2017.

6.      Tang, K.M., et al. "Decreasing prescribing errors in antimicrobial stewardship program-restricted medications." Hosp Pediatr, 2024;14(4):281-290.