Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman.
Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman; Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman.
J Infect Public Health. 2024 May;17(5):819-824. doi: 10.1016/j.jiph.2024.03.013. Epub 2024 Mar 16.
Antimicrobial resistance is associated with increasing mortality rates and the emergence of multidrug-resistant (MDR) organisms. There is scarcity of data on the short-term impact of Antimicrobial Stewardship Programs (ASP) on antibiotic usage, clinical outcome and MDR organisms' pattern following the COVID-19 pandemic. This study evaluated the short-term effects of ASP on antibiotic usage, clinical outcomes and MDR organisms' pattern in the post COVID-19 era.
Conducted at a tertiary academic health center, this observational study involved adult patients (≥18 years) in the general medical unit, treated with oral or intravenous antibiotics from May 1, 2021, to April 30, 2022. The applied ASP strategy was a prospective audit and feedback where a weekly meeting was held to discuss the antimicrobial therapy of admitted patient, after which recommendations were made regarding antimicrobial use.
The study included 301 patients with 166 (55.1%) pre-ASP and 135 (44.9%) post-ASP. The median (IQR) age was 69 (55-77) years with 56.1% were female. Antibiotic usage dropped by 25.2% post-ASP. The length of hospital stay (LOS) was longer post-ASP (7 days vs. 7.9 days, p = 0.001), with MDR infections being a significant predictor (OR: 0.486, p < 0.001). There were no significant differences in 28-day readmission, recurrence of infections and all-cause mortality. Post-ASP, MDR pathogens increased (17.0% vs. 6.6%, p = 0.013), however, after separating post-ASP into two three-months periods, MDROs numbers decreased slightly (13 vs. 10).
Short-term ASP implementation post COVID-19 reduced antibiotic usage while other clinical outcomes remained unchanged. Nonetheless an increase in MDR pathogens and LOS was observed. Further research is required to assess ASP's long-term impact on MDR infections rates and specific patient group outcomes.
抗菌药物耐药性与死亡率的上升和多药耐药（MDR）病原体的出现有关。关于 COVID-19 大流行后抗菌药物管理计划（ASP）对抗生素使用、临床结果和 MDR 病原体模式的短期影响的数据稀缺。本研究评估了 ASP 在 COVID-19 后时代对抗生素使用、临床结果和 MDR 病原体模式的短期影响。
在一家三级学术医疗中心进行的这项观察性研究，涉及 2021 年 5 月 1 日至 2022 年 4 月 30 日期间在普通医疗病房接受口服或静脉用抗生素治疗的成年患者（≥18 岁）。应用的 ASP 策略是前瞻性审核和反馈，每周举行一次会议讨论住院患者的抗菌治疗，之后提出关于抗菌药物使用的建议。
该研究纳入了 301 名患者，其中 166 名（55.1%）为 ASP 前，135 名（44.9%）为 ASP 后。中位（IQR）年龄为 69（55-77）岁，56.1%为女性。ASP 后抗生素使用率下降了 25.2%。ASP 后住院时间（LOS）较长（7 天 vs. 7.9 天，p=0.001），MDR 感染是显著预测因素（OR：0.486，p<0.001）。28 天再入院率、感染复发率和全因死亡率无显著差异。ASP 后，MDR 病原体增加（17.0% vs. 6.6%，p=0.013），然而，将 ASP 后分为两个三个月期后，MDRO 数量略有下降（13 对 10）。
COVID-19 后实施短期 ASP 减少了抗生素的使用，而其他临床结果保持不变。然而，观察到 MDR 病原体和 LOS 的增加。需要进一步研究来评估 ASP 对 MDR 感染率和特定患者群体结局的长期影响。
