Implementation of an antimicrobial stewardship program in Alexandria University Children's Hospital: an interventional study.

BACKGROUND

Antimicrobial resistance (AMR) represents a threat to global public health. The antibiotics' effectiveness against a variety of infections consequently has been declined with increasing morbidity, mortality, and treatment failure. To combat this, the implementation of Antimicrobial Stewardship Programs (ASPs) is essential for slowing the spread of resistant pathogens.

AIM OF THE WORK: The current study aimed to assess the outcomes following implementation of Antimicrobial Stewardship Program (ASP) at Alexandria University Children's Hospital.

METHOD: The study was conducted over nine months in a general pediatric ward. First, the medical records and microbiological reports were reviewed to establish tailored antibiotic guidelines. During the intervention phase, the ASP focused on prospective audits and physicians' education. The program's impact was evaluated through several key metrics: adherence to the guidelines, patient outcome (mortality rate and length of stay) and antibiotic consumption (expenditure, days of therapy, and treatment duration). All statistical analyses were conducted using IBM SPSS version 20.0.

RESULTS

219 patients in the preintervention phase were compared to 214 patients (post-intervention). Following ASP, the use of single antibiotics increased in post-intervention (69.6% versus 26%). During the study period, 70 interventions were required with a high acceptance rate (59%). The mean length of hospital stays decreased [10.80 (3-26) versus 12.89 (4-33) days], and both DOT/1000 patients and the average cost of antibiotics decreased (27.82% and 44.94%, respectively). Following ASP, the use of Tigecycline (-100%), Meropenem (-57.79%), and Vancomycin (-46.35%) reduced with an increase in the use of Cefotaxime (80.43%), Ceftriaxone (20.27%), and Ceftazidime (62.87%).

CONCLUSION

The implementation of institutional guidelines along with Prospective Audit and Feedback (PAF) was associated with improvements in antibiotic utilization, particularly in the resource-limited settings.

CLINICAL TRIAL NUMBER: Not applicable.