Implementation of a multidisciplinary antimicrobial stewardship programme in a Philippine tertiary care hospital: an evaluation by repeated point prevalence surveys

Gina de Guzman Betito; Ines Pauwels; Ann Versporten; Herman Goossens; Mari Rose De Los Reyes; Maria Tarcela Gler

doi:10.1016/j.jgar.2021.05.009

Implementation of a multidisciplinary antimicrobial stewardship programme in a Philippine tertiary care hospital: an evaluation by repeated point prevalence surveys

J Glob Antimicrob Resist. 2021 Sep:26:157-165. doi: 10.1016/j.jgar.2021.05.009. Epub 2021 Jun 10.

Authors

Gina de Guzman Betito¹, Ines Pauwels², Ann Versporten³, Herman Goossens³, Mari Rose De Los Reyes⁴, Maria Tarcela Gler¹

Affiliations

¹ Makati Medical Center, Makati City, Philippines.
² Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium. Electronic address: ines.pauwels@uantwerpen.be.
³ Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
⁴ Research Institute for Tropical Medicine, Filinvest Corporate City, Alabang, Muntinlupa City, Philippines.

PMID: 34118483
DOI: 10.1016/j.jgar.2021.05.009

Abstract

Objectives: Optimising antimicrobial prescribing in hospitals through antimicrobial stewardship (AMS) is essential in addressing the global threat of antimicrobial resistance. The objective of this study was to evaluate the impact of a hospital-wide programme, delivered by a multidisciplinary AMS team, on antimicrobial prescribing outcomes.

Methods: The AMS programme consisted of a combination of persuasive, restrictive, and structural components and was implemented in two phases. We used data from the Global-PPS, collected every six months between September 2017 and December 2019, to measure the antimicrobial use prevalence and monitor selected antibiotic prescribing quality indicators.

Results: A significantly increasing trend (P < 0.001) was observed for the indicators related to documentation of prescribing, that is the reason for treatment and stop or review date. We observed a significantly decreasing trend (P < 0.001) in the number of prescriptions for surgical antibiotic prophylaxis (SAP) prescribed for more than 24 h; however, sample sizes for surgical patients were small. For these three indicators, a sudden and pronounced improvement was seen after the second set of interventions, which consisted of (i) an antibiotic documentation policy, (ii) a 24-h automatic stop order for SAP, and (iii) dissemination of new SAP guidelines. A significantly decreasing trend was also observed for hospital-wide antimicrobial use prevalence (P < 0.001).

Conclusions: The implementation of a multidisciplinary antimicrobial stewardship programme positively influenced antibiotic prescribing practices. Further research should address long-term trends in antibiotic prescribing to establish whether these coordinated activities have led to a sustained behaviour change among prescribers, thereby also evaluating clinical outcomes and antimicrobial resistance rates.

Keywords: Antimicrobial stewardship; Hospital; Philippines; Point prevalence survey; Quality indicators.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Antimicrobial Stewardship*
Humans
Philippines
Prevalence
Tertiary Care Centers

Substances

Anti-Bacterial Agents