Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar

Mazen A Sid Ahmed; Hamad Abdel Hadi; Sulieman Abu Jarir; Abdul Latif Al Khal; Muna A Al-Maslamani; Jana Jass; Emad Bashir Ibrahim; Hisham Ziglam

doi:10.1093/jacamr/dlaa050

Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar

JAC Antimicrob Resist. 2020 Aug 7;2(3):dlaa050. doi: 10.1093/jacamr/dlaa050. eCollection 2020 Sep.

Authors

Mazen A Sid Ahmed^{1

2}, Hamad Abdel Hadi³, Sulieman Abu Jarir³, Abdul Latif Al Khal³, Muna A Al-Maslamani³, Jana Jass², Emad Bashir Ibrahim^{1

4}, Hisham Ziglam³

Affiliations

¹ Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
² The Life Science Centre-Biology, School of Science and Technology, Örebro University, Örebro, Sweden.
³ Departments of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar.
⁴ Biomedical Research Center, Qatar University, Doha, Qatar.

Abstract

Background: The excessive and inappropriate use of antibiotics is universal across all healthcare facilities. In Qatar there has been a substantial increase in antimicrobial consumption coupled with a significant rise in antimicrobial resistance (AMR). Antimicrobial stewardship programmes (ASPs) have become a standard intervention for effective optimization of antimicrobial prescribing.

Methods: A before-after study was conducted in Hamad General Hospital (603 bed acute care hospital): 1 year before implementation of a comprehensive ASP compared with the following 2 years. The ASP included a hospital-wide pre-authorization requirement by infectious diseases physicians for all broad-spectrum antibiotics. Prevalence of MDR Pseudomonas aeruginosa was compared with antimicrobial consumption, calculated as DDD per 1000 patient-days (DDD/1000 PD). Susceptibility was determined using broth microdilution, as per CLSI guidelines. Antibiotic use was restricted through the ASP, as defined in the hospital's antibiotic policy.

Results: A total of 6501 clinical isolates of P. aeruginosa were collected prospectively over 3 years (2014-17). Susceptibility to certain antimicrobials improved after the ASP was implemented in August 2015. The prevalence of MDR P. aeruginosa showed a sustained decrease from 2014 (9%) to 2017 (5.46%) (P = 0.019). There was a significant 23.9% reduction in studied antimicrobial consumption following ASP implementation (P = 0.008). The yearly consumption of meropenem significantly decreased from 47.32 to 31.90 DDD/1000 PD (P = 0.012), piperacillin/tazobactam from 45.35 to 32.67 DDD/1000 PD (P < 0.001) and ciprofloxacin from 9.71 to 5.63 DDD/1000 PD (P = 0.015) (from 2014 to 2017).

Conclusions: The successful implementation of the ASP led to a significant reduction in rates of MDR P. aeruginosa, pointing towards the efficacy of the ASP in reducing AMR.