Haseeb Abdul, Faidah Hani Saleh, Al-Gethamy Manal, Iqbal Muhammad Shahid, Barnawi Abrar Mohammed, Elahe Shuruq S, Bukhari Duha Nabeel, Noor Al-Sulaimani Turki Mohammad, Fadaaq Mohammad, Alghamdi Saad, Almalki Waleed Hassan, Saleem Zikria, Elrggal Mahmoud Essam, Khan Amer Hayat, Algarni Mohammed A, Ashgar Sami S, Hassali Mohamed Azmi
Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Al-Abdia Campus, Makkah, Saudi Arabia.
Department of Microbiology, Faculty of Medicine, Umm Al Qura University, Saudi Arabia.
Front Pharmacol. 2021 Mar 10;11:570238. doi: 10.3389/fphar.2020.570238. eCollection 2020.
Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. With regard to critically ill patients, appropriate antimicrobial usage is of significance, and any delay in therapy increases their risk of mortality. Therefore, the implementation of structured multidisciplinary ASPs in critical care settings is of the utmost importance to promote the judicious use of antimicrobials. This quasi-experimental study evaluating a multidisciplinary ASP in a 20-bed critical care setting was conducted from January 1, 2016 to July 31, 2017. Outcomes were compared nine months before and after ASP implementation. The national antimicrobial stewardship toolkit by Ministry of health was reviewed and the hospital antibiotic prescribing policy was accordingly modified. The antimicrobial stewardship algorithm (Start Smart and Then Focus) and an ASP toolkit were distributed to all intensive care unit staff. Prospective audit and feedback, in addition to prescribing forms for common infectious diseases and education, were the primary antimicrobial strategies. We found that the mean total monthly antimicrobial consumption measured as defined daily dose per 100 bed days was reduced by 25% (742.86 vs. 555.33; = 0.110) compared to 7% in the control condition (tracer medications) (35.35 vs. 38.10; = 0.735). Interestingly, there was a negative impact on cost in the post-intervention phase. Interestingly, the use of intravenous ceftriaxone measured as defined daily dose per 100 bed days was decreased by 82% (94.32 vs. 16.68; = 0.008), whereas oral levofloxacin use was increased by 84% (26.75 vs. 172.29; = 0.008) in the intensive care unit. Overall, involvement of higher administration in multidisciplinary ASP committees, daily audit and feedback by clinical pharmacists and physicians with infectious disease training, continuous educational activities about antimicrobial use and resistance, use of local antimicrobial prescribing guidelines based on up-to-date antibiogram, and support from the intensive care team can optimize antibiotic use in Saudi healthcare institutions.
抗菌药物管理计划（ASPs）是通过基于证据的质量改进策略，在医疗机构中优化抗菌药物使用的协作性努力。对于重症患者而言，恰当使用抗菌药物至关重要，而治疗的任何延迟都会增加其死亡风险。因此，在重症监护环境中实施结构化的多学科抗菌药物管理计划对于促进抗菌药物的合理使用极为重要。这项在拥有20张床位的重症监护环境中评估多学科抗菌药物管理计划的准实验研究，于2016年1月1日至2017年7月31日进行。对实施抗菌药物管理计划前后九个月的结果进行了比较。审查了卫生部的国家抗菌药物管理工具包，并相应修改了医院抗生素处方政策。将抗菌药物管理算法（先明智起始然后聚焦）和一个抗菌药物管理计划工具包分发给了所有重症监护病房的工作人员。除了常见传染病的处方表格和教育之外，前瞻性审核与反馈是主要的抗菌策略。我们发现，与对照情况（追踪药物）中7%的降幅（35.35对38.10；P = 0.735）相比，以每100床日限定日剂量衡量的每月抗菌药物总消耗量均值降低了25%（742.86对555.33；P = 0.110）。有趣的是，干预后阶段对成本产生了负面影响。有趣的是，在重症监护病房中，以每100床日限定日剂量衡量的静脉注射头孢曲松的使用量减少了82%（94.32对16.68；P = 0.008），而口服左氧氟沙星的使用量增加了84%（26.75对172.29；P = 0.008）。总体而言，高级管理层参与多学科抗菌药物管理计划委员会、接受传染病培训的临床药师和医生进行每日审核与反馈、开展关于抗菌药物使用和耐药性的持续教育活动、使用基于最新抗菌谱的当地抗菌药物处方指南以及重症监护团队的支持，能够优化沙特医疗机构中的抗生素使用。
