The Impact of the Antimicrobial Stewardship Program on Antibiotic Use, Resistance Patterns, and Cost in Madinat Zayed Hospital

  • Ashraf ALakkad Department of Internal Medicine, Madinat Zayed Hospital, AL Dhafra Region, UAE https://orcid.org/0000-0002-4083-2800
  • Yazan Ayaad Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE
  • Zill Huma Hussain Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE
  • Egbal Mohmed Suleimen Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE
  • Anas Alhomran Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE
  • Hesham Abdalla Department of Internal Medicine, Madinat Zayed Hospital, AL Dhafra Region, UAE

Abstract

Antimicrobial resistance and excessive antibiotic usage are a growing public health concern. Antimicrobial Stewardship Programs (ASPs) aim to optimize antibiotic use and curb resistance. This retro-respective study evaluated the impact of an ASP at Madinat Zayed Hospital, Abu Dhabi (January 2021-December 2022). It analyzed electronic health records to assess the ASP's impact on antibiotic consumption, resistance patterns, and economic outcomes. Patients from intensive care units, medical wards, and outpatient settings were included, though patients admitted to obstetrics/gynaecology, paediatrics, neonatal intensive care, and surgical wards were excluded. The primary objective of this study was to report on the ASP experience and measure the prescribing appropriateness percentage of empirical antibiotic therapy along with the de-escalation of broad-spectrum antimicrobials, after ASP implementation at Madinat Zayed Hospital in Al Dhafra Region, United Arab Emirates. The secondary objectives were to reflect on the rate of Multidrug-Resistant Organisms (MDROs), total utilization using defined daily dose, and the total direct cost of antibiotics. Descriptive analysis, proportions, mean values, and percentage changes were employed for data analysis. The ASP achieved high compliance rates with restricted antibiotics (>90%) and approved guidelines (inpatient 97-100%, outpatient 93-98%). Antibiotic de-escalation rates were also high (>80%).  Significant reductions in use were observed for cefixime (91.3%), levofloxacin (46.3%), and several others. Notably, cefepime use increased (1137.5%). Direct antibiotic expenditure decreased by 2% (saving Dhs2.6 million), and resistance decreased in some bacteria. However, a concerning rise in ceftazidime resistance against Pseudomonas aeruginosa was identified. This study concluded that the implementation of a new Antimicrobial Stewardship Program at Madinat Zayed Hospital demonstrated effectiveness in promoting responsible antibiotic use. The program achieved high compliance with restricted antibiotic use and approved guidelines, leading to significant reductions in overall antibiotic consumption.


Keywords: Antimicrobial, resistance, Multidrug-Resistant Organisms, de-escalation, consumption

Keywords: Antimicrobial, resistance, Multidrug-Resistant Organisms, de-escalation, consumption

Downloads

Download data is not yet available.

Author Biographies

Ashraf ALakkad, Department of Internal Medicine, Madinat Zayed Hospital, AL Dhafra Region, UAE

Department of Internal Medicine, Madinat Zayed Hospital, AL Dhafra Region, UAE

Yazan Ayaad, Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Zill Huma Hussain, Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Egbal Mohmed Suleimen, Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Anas Alhomran, Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Department of Pharmacy, Madinat Zayed Hospital, AL Dhafra Region, UAE

Hesham Abdalla, Department of Internal Medicine, Madinat Zayed Hospital, AL Dhafra Region, UAE

Department of Internal Medicine, Madinat Zayed Hospital, AL Dhafra Region, UAE

References

[1] L. Price et al., "Effectiveness of interventions to improve the public's antimicrobial resistance awareness and behaviours associated with prudent use of antimicrobials: a systematic review," Journal of Antimicrobial Chemotherapy, vol. 73, no. 6, pp. 1464-1478, 2018. https://doi.org/10.1093/jac/dky076 PMid:29554263
[2] T. M. File Jr, A. Srinivasan, and J. G. Bartlett, "Antimicrobial stewardship: importance for patient and public health," Clinical Infectious Diseases, vol. 59, no. suppl_3, pp. S93-S96, 2014. https://doi.org/10.1093/cid/ciu543 PMid:25261547 PMCid:PMC6487653
[3] J. O'Neill, "Tackling drug-resistant infections globally: final report and recommendations," 2016.
[4] S. Allcock et al., "Antimicrobial resistance in human populations: challenges and opportunities," Global Health, Epidemiology and Genomics, vol. 2, p. e4, 2017. https://doi.org/10.1017/gheg.2017.12 PMid:29869630 PMCid:PMC5870469
[5] R. J. Glaser, "General principles of antibiotic therapy," The Journal of the American Dental Association, vol. 46, no. 2, pp. 129-134, 1953. https://doi.org/10.14219/jada.archive.1953.0022 PMid:13022248
[6] J. McGowan Jr and D. Gerding, "Does antibiotic restriction prevent resistance?," New Horizons (Baltimore, Md.), vol. 4, no. 3, pp. 370-376, 1996.
[7] A. Hakanen, J. Jalava, and L. Kaartinen, "The National Action Plan on Antimicrobial Resistance 2017-2021," 2017.
[8] M. Mendelson, M. Balasegaram, T. Jinks, C. Pulcini, and M. Sharland, "Antibiotic resistance has a language problem," Nature, vol. 545, no. 7652, pp. 23-25, 2017. https://doi.org/10.1038/545023a PMid:28470219
[9] O. Dyar, B. Huttner, J. Schouten, and C. Pulcini, "What is antimicrobial stewardship?," Clinical Microbiology and Infection, vol. 23, no. 11, pp. 793-798, 2017. https://doi.org/10.1016/j.cmi.2017.08.026 PMid:28882725
[10] E. C. Schuts et al., "Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis," The Lancet Infectious Diseases, vol. 16, no. 7, pp. 847-856, 2016. https://doi.org/10.1016/S1473-3099(16)00065-7 PMid:26947617
[11] J. Emberger, D. Tassone, M. P. Stevens, and J. D. Markley, "The current state of antimicrobial stewardship: challenges, successes, and future directions," Current Infectious Disease Reports, vol. 20, pp. 1-12, 2018. https://doi.org/10.1007/s11908-018-0637-6
[12] C. Pallares et al., "Impact of antimicrobial stewardship programs on antibiotic consumption and antimicrobial resistance in four Colombian healthcare institutions," BMC Infectious Diseases, vol. 22, no. 1, p. 420, 2022/05/02 2022, https://doi.org/10.1186/s12879-022-07410-6 PMid:35501756 PMCid:PMC9059380
[13] D. A. Goff et al., "A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail," The Lancet Infectious Diseases, vol. 17, no. 2, pp. e56-e63, 2017. https://doi.org/10.1016/S1473-3099(16)30386-3 PMid:27866945
[14] J. A. Cox et al., "Antibiotic stewardship in low-and middle-income countries: the same but different?," Clinical Microbiology and Infection, vol. 23, no. 11, pp. 812-818, 2017. https://doi.org/10.1016/j.cmi.2017.07.010 PMid:28712667
[15] P. Davey et al., "Interventions to improve antibiotic prescribing practices for hospital inpatients," Cochrane Database of Systematic Reviews, no. 4, 2013. https://doi.org/10.1002/14651858.CD003543.pub3
[16] "Madinat Zayed Hospital, UAE." https://ehaf.com/project/madinat-zayed-hospital-uae (accessed.
[17] L. Bao et al., "Significant reduction of antibiotic consumption and patients' costs after an action plan in China, 2010-2014," PLoS One, vol. 10, no. 3, p. e0118868, 2015, https://doi.org/10.1371/journal.pone.0118868 PMid:25767891 PMCid:PMC4359138
[18] P. March-López et al., "Impact of a Multifaceted Antimicrobial Stewardship Intervention in a Primary Health Care Area: A Quasi-Experimental Study," Frontiers in Pharmacology, Brief Research Report vol. 11, 2020, https://doi.org/10.3389/fphar.2020.00398 PMid:32300302 PMCid:PMC7142248
[19] M. Frieri, K. Kumar, and A. Boutin, "Antibiotic resistance," Journal of Infection and Public Health, vol. 10, no. 4, pp. 369-378, 2017. https://doi.org/10.1016/j.jiph.2016.08.007 PMid:27616769
[20] J. Thomsen et al., "Surveillance of antimicrobial resistance in the United Arab Emirates: the early implementation phase," Frontiers in Public Health, vol. 11, p. 1247627, 2023. https://doi.org/10.3389/fpubh.2023.1247627 PMid:38074700 PMCid:PMC10704098
[21] L. C. McDonald, "Trends in antimicrobial resistance in health care-associated pathogens and effect on treatment," Clinical Infectious Diseases, vol. 42, no. Supplement_2, pp. S65-S71, 2006. https://doi.org/10.1086/499404 PMid:16355319
[22] M. M. Alawi and B. M. Darwesh, "A stepwise introduction of a successful antimicrobial stewardship program: Experience from a tertiary care university hospital in Western, Saudi Arabia," Saudi Medical Journal, vol. 37, no. 12, p. 1350, 2016. https://doi.org/10.15537/smj.2016.12.15739 PMid:27874151 PMCid:PMC5303774
[23] D. P. Nicolau, "Current challenges in the management of the infected patient," Current Opinion in Infectious Diseases, vol. 24, pp. S1-S10, 2011. https://doi.org/10.1097/01.qco.0000393483.10270.ff PMid:21200179
[24] B. M. Aiesh, M. A. Nazzal, A. I. Abdelhaq, S. A. Abutaha, S. E. H. Zyoud, and A. Sabateen, "Impact of an antibiotic stewardship program on antibiotic utilization, bacterial susceptibilities, and cost of antibiotics," Scientific Reports, vol. 13, no. 1, p. 5040, 2023. https://doi.org/10.1038/s41598-023-32329-6 PMid:36977796 PMCid:PMC10043847
[25] D. N. Schwartz et al., "An Educational Intervention to Improve Antimicrobial Use in a Hospital‐Based Long‐Term Care Facility: (See Editorial Comments by Dr. Lona Mody on pp 1301-1302)," Journal of the American Geriatrics Society, vol. 55, no. 8, pp. 1236-1242, 2007. https://doi.org/10.1111/j.1532-5415.2007.01251.x PMid:17661963
[26] B. W. Trautner et al., "Effectiveness of an antimicrobial stewardship approach for urinary catheter-associated asymptomatic bacteriuria," JAMA Internal Medicine, vol. 175, no. 7, pp. 1120-1127, 2015. https://doi.org/10.1001/jamainternmed.2015.1878 PMid:26010222
[27] D. Nathwani, D. Varghese, J. Stephens, W. Ansari, S. Martin, and C. Charbonneau, "Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review," Antimicrobial Resistance & Infection Control, vol. 8, pp. 1-13, 2019. https://doi.org/10.1186/s13756-019-0471-0 PMid:30805182 PMCid:PMC6373132
[28] M. A. Sid Ahmed et al., "Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar," JAC-Antimicrobial Resistance, vol. 2, no. 3, p. dlaa050, 2020. https://doi.org/10.1093/jacamr/dlaa050 PMid:34223010 PMCid:PMC8210253
[29] B. M. Aiesh, M. A. Nazzal, A. I. Abdelhaq, S. A. Abutaha, S. H. Zyoud, and A. Sabateen, "Impact of an antibiotic stewardship program on antibiotic utilization, bacterial susceptibilities, and cost of antibiotics," Sci Rep, vol. 13, no. 1, p. 5040, Mar 28 2023, https://doi.org/10.1038/s41598-023-32329-6 PMid:36977796 PMCid:PMC10043847
Crossmark
Statistics
97 Views | 8 Downloads
How to Cite
1.
ALakkad A, Ayaad Y, Hussain ZH, Suleimen EM, Alhomran A, Abdalla H. The Impact of the Antimicrobial Stewardship Program on Antibiotic Use, Resistance Patterns, and Cost in Madinat Zayed Hospital. JDDT [Internet]. 15Jun.2024 [cited 17Jul.2024];14(6):51-8. Available from: https://jddtonline.info/index.php/jddt/article/view/6553