Department of Pharmacy, Singapore General Hospital, Blk 8, Level 2, Outram Road, 169608, Singapore, Singapore.
Eur J Clin Microbiol Infect Dis. 2012 Jun;31(6):947-55. doi: 10.1007/s10096-011-1391-y. Epub 2011 Sep 10.
Inappropriate antibiotic use contributes to antimicrobial resistance. Multi-faceted antimicrobial stewardship programmes (ASPs) are recommended for sustainable changes in prescribing practices. A multi-disciplinary ASP was established in October 2008 and piloted in the Departments of General Surgery, Renal Medicine and Endocrinology sequentially. To improve the quality of patient care via optimising the (1) choice, (2) dose, (3) route and (4) duration of antibiotics, a "whole-system" approach incorporating prospective review with immediate concurrent feedback (ICF), prescriber education (public or individualised), de-escalation of therapy, dose optimisation and parenteral-to-oral conversion, while recognising the autonomy of primary prescribers, was adopted. The audited department received a quarterly outcomes report and any common unaccepted practices would be addressed. Outcomes were analysed for 12 months post-ASP implementation. A total of 1,535 antibiotic prescriptions were reviewed. Antimicrobial use in 376 (24.5%) prescriptions was inappropriate. Of 596 interventions made, 70.2% were accepted. A reduction in audited antibiotics consumption resulted in acquisition cost savings of S$198,575 for the hospital. Patients' cost-savings attributable to ASP-initiated interventions were $91,194. The overall all-cause mortality rate and median monthly inpatient-days pre- and post-intervention remained stable. A "whole-system" ASP was effective in optimising antibiotic use in our hospital, without compromising clinical outcomes.
不适当的抗生素使用导致了抗菌药物耐药性的产生。推荐采用多方面的抗菌药物管理项目（ASPs）来持续改变处方实践。一个多学科的 ASP 于 2008 年 10 月成立，并在普外科、肾脏内科和内分泌科依次进行了试点。为了通过优化抗生素的（1）选择、（2）剂量、（3）途径和（4）持续时间来提高患者的护理质量，采用了一种“整体系统”方法，包括前瞻性审查和即时的同期反馈（ICF）、处方医生教育（公开或个体化）、治疗降级、剂量优化和肠外给药转为口服给药，同时承认初级处方医生的自主权。经过审核的科室会收到一份季度结果报告，并解决任何常见的不可接受的做法。在 ASP 实施后的 12 个月内分析了结果。共审查了 1535 份抗生素处方。在 376 份（24.5%）处方中，抗菌药物的使用是不适当的。在 596 次干预中，有 70.2%被接受。审核抗生素使用量的减少为医院节省了 198575 新元的购买成本。由于 ASP 干预而节省的患者成本为 91194 美元。在干预前后，患者的全因死亡率和每月住院天数中位数保持稳定。一个“整体系统”的 ASP 能够有效地优化我们医院的抗生素使用，而不会影响临床结果。
