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BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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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Copyright
© 2019 Published by Elsevier Inc.
