Impact of an integrated stewardship intervention at a secondary care hospital in Ras Al Khaimah, United Arab Emirates: findings from September 2018-March 2019.

BACKGROUND

Healthcare systems have been increasingly utilizing antimicrobial stewardship programs (ASPs) as a focused effort to optimize antimicrobial prescribing practices. Prospective audit and feedback intervention (PAFI) are important core ASP strategy. Notwithstanding global data endorsing the efficacy of ASPs, a considerable gap persists in their implementation and evaluation within the United Arab Emirates (UAE), where most hospitals are still in the early stages of ASP adoption, and published local data on the impact of ASP initiatives, notably PAFI, is limited. Therefore, the present study aims to address this gap by comparing the impact of PAFI on antimicrobial prescribing between the pre-ASP and post-ASP periods in a UAE Government hospital. This evaluation will furnish evidence to inform future policy, enhance stewardship practices, and aid the national initiative to combat antimicrobial resistance.

METHODS

The current study was a quasi-experimental pre-post intervention study with retrospective and prospective data collection, and included data from the electronic medical records of adult inpatients admitted to the secondary care government hospital in Ras Al Khaimah, United Arab Emirates who underwent clean or clean-contaminated major surgeries. We evaluated the impact of PAFI on the prescribing practices of surgical prophylactic antibiotics. In the pre-intervention phase (PIP), the data of 409 patients was collected for major operations done between September 2018 to October 2018. The post intervention evaluation phase (PIEP) contained data collected for surgical procedures conducted on 336 patients between February 2019 to March 2019.

RESULTS

The surgical site infections rate decreased from 0.14% to 0.0% and the selection of antibiotics improved in PIEP, increasing from 67.5% to 76.5% (p = 0.006). However, the total adherence rate decreased from 36.4% to 31.9% due to the prolonged postoperative duration of antibiotics (p = 0.154) and the improper administration of the first prophylactic dose within 1 h of incision (296; 88.1%) in PIEP (p = 0.002). The average antimicrobial cost per procedure was higher in PIEP (19.85 AED) as compared to PIP (p < 0.000) due to the concurrent reduction in ceftriaxone usage and increase in cefuroxime administration, in addition to the increased duration of surgical prophylaxis.

CONCLUSION

This study demonstrates that the incorporation of prospective audit and feedback intervention into the newly implemented antimicrobial stewardship program in the hospital enhanced the selection of surgical prophylactic antibiotics and supported the reduction in surgical site infection rates. However, challenges persist, particularly in maintaining adherence to the recommended timing and duration of prophylaxis, which limited overall compliance and led to higher antimicrobial costs. These findings emphasize the importance of continuous cycles of antibiotic stewardship audit-feedback interventions to standardize prescribing practices and enhance surgical prophylaxis outcomes in the UAE healthcare setting.