Impact of Antimicrobial Stewardship program on Hospitalized Patients at the Intensive Care Unit: A prospective Audit and feedback Study

Aims

Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of Antimicrobial Stewardship Program (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex.

Methods

A prospective audit with intervention and feedback by ASP team within 48-72h of antibiotic administration began in Sep, 2015. Four months of pre-ASP data with 4-months of post-ASP data were compared. Data collected included clinical and demographic data; utilization of antimicrobials measured by Define Daily Doses, duration of therapy, length of stay, readmission and all-cause mortality.

Results

Overall, 176 interventions were made the ASP team with an average acceptance rate of 78.4%. The most accepted interventions were dose optimization (87.0%) followed by de-escalation based on culture results with an acceptance rate of 84.4%. ASP interventions significantly reduces antimicrobial utilization by 24.3% (87.3 DDD/100 bed. vs 66.1 DDD/100 bed p<0.001). The median (IQR) of length of stay was significantly reduced post ASP (11 (3-21) vs. 7 (4-19) days; p <0.01). Also, the median (IQR) of duration of therapy was significantly reduced post-ASP (8 (5-12) days vs. 5 (3-9); p=0.01). There was no significant difference in overall 30-day mortality or readmission between the pre-ASP and post-ASP groups (26.9% vs. 23.9%; p=0.1) and (26.1% vs. 24.6%; p=0.54) respectively.

Conclusions

Our prospective audit and feedback program was associated with positive impact on antimicrobial utilization, duration of therapy and length of stay.

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