English abstract
Background: Antimicrobial overuse and misuse have been linked to the emergence of
antimicrobial resistance (AMR) which is considered a major health problem with
significant clinical and economic impacts. Antimicrobial stewardship programs (ASP) are
developed to optimize the use of antimicrobial agents within hospitals to reduce
antimicrobial side effects including AMR.
Objectives: The primary objective of this study was to determine the rate and pattern of
multidrug resistance (MDR) organisms at SQUH before and after the implementation of
ASP. Also, to determine the rate and pattern of antimicrobial utilization, total
antimicrobial cost, and impact on clinical outcomes.
Methods: A single-center prospective observational cohort with a retrospective arm that
included all general medical adult patients admitted to SQUH under the care of general
medicine team and treated with oral or intravenous antibiotics. The retrospective arm
included all patients admitted between May 1st, 2021, to October 30th, 2021, while the
prospective arm included patients admitted and discussed with the ASP team between
November 1st, 2021, to April 30th, 2022.
Results: MDR pathogens were significantly higher post-ASP implementation than preASP implementation (17% vs. 6.6%, P = 0.013). There was also an increase in the total
antimicrobial costs post-ASP implementation (from 3583.519 R.O. to 9104.344 R.O.).
Antimicrobial consumption, on the other hand, decreased by 25.2% post-ASP
implementation from 944.9 DDD/1000 patient days pre-ASP to 706.8 DDD/1000 patient
days post-ASP. The length of hospital stay (LOS) was found to be significantly longer
post-ASP (7 vs. 7.9, P =0.001). Finally, there was no significant change in 28-days
mortality rate, readmissions, and new onset of infection within 28 days post-ASP.
Conclusion: ASP was associated with a decrease in total antimicrobial consumption.
Although there was an increase in MDR rate post-ASP, there was a noticeable drop in
MDR rate during the last three months of the study. LOS was longer post-ASP, while
there were no significant changes in other clinical outcomes post-ASP.
