Presentation Number ASR-1| Volume 47, ISSUE 6, SUPPLEMENT , S2-S3, June 2019

Leading an Antibiotic Stewardship Initiative Through a Quality Improvement Collaborative Among 22 Hospitals in a Lower Middle Income Country

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      The emergence of colistin resistant Carbapenem Resistant Enterobacteriaceae (CRE's) within a period of 4 months caused a team of professionals to raise the alarm. In a country lacking standardized microbiological testing, no restriction on antibiotics usage and having basic infection prevention programs, there was a need to address antimicrobial stewardship (AMS) nationally. The success of one tertiary hospital in building an AMS program resulted in a national initiative for 22 hospitals.


      The AMS program design included a driver diagram for the hospitals covering a catchment area of approximately 80% of the total population. A multidisciplinary team of 5 members from each hospital was responsible for implementing the activities which included; standardization of microbiological testing through hands-on workshops utilizing the American Society for Microbiology and the Clinical and Laboratory Standard Institute (CLSI) guidelines. Developing evidence based national guidelines for infections and empiric treatment and building the capacity of clinical pharmacists, medical doctors, infection control coordinators through shadowing of the AMS core team at the tertiary hospital. A data collection sheet was developed using Microsoft Access to collect data about antibiotics Days of Therapy (DoT) in line with CDC guidelines to evaluate improvements.


      The effect of the AMS program was noted by a statistically significant drop in the restricted antibiotics DoT ranging between 23-74% in the vancomycin, colistin and carbapenems usage (p < 0.05). No deterioration in the medical outcome of patients occurred and the infection related mortality dropped by 71.4% during the 5-month period (p < 0.05), using Cochran armitage test for linear trends for significance. On average 84% of all patients receiving antibiotics were treated according to the guidelines and financial savings were reported.


      The achievements of AMS interventions with minimal resources can be used as a model for regional countries in the fight against the spread of resistant bacteria.
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