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

• Main Authors: Gina de Guzman Betito, Ines Pauwels, Ann Versporten, Herman Goossens, Mari Rose De Los Reyes, Maria Tarcela Gler
• Format: Article
• Language: English
• Published: Elsevier 2021-09-01
• Series: Journal of Global Antimicrobial Resistance
• Subjects: Point prevalence survey; Antimicrobial stewardship; Philippines; Hospital; Quality indicators
• Online Access: http://www.sciencedirect.com/science/article/pii/S2213716521001405

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.