Li Wen Loo1, Yi Xin Liew1, Winnie Lee1, Lai Wei Lee1, Piotr Chlebicki2, Andrea Lay-Hoon Kwa3. 1. Department of Pharmacy, Singapore General Hospital, Singapore. 2. Department of Infectious Diseases, Singapore General Hospital, Singapore. 3. Department of Pharmacy, Singapore General Hospital, Singapore; Emerging Infectious Diseases Program, Duke-NUS Graduate Medical School, Singapore. Electronic address: andrea.kwa.l.h@sgh.com.sg.
Abstract
BACKGROUND: Overprescribing antibiotics for patients with no bacterial infection is of growing global concern. It is important for timely Antimicrobial Stewardship Program (ASP) intervention to discontinue antibiotics for patients whose symptoms can be explained by non-infective causes, and without availability of bacterial cultures and susceptibilities reports. This study aimed to evaluate clinical outcomes and safety of early ASP review in these patients. METHODS: A retrospective review of the ASP database (January 2010 to December 2014) was conducted to identify patients for whom ASP recommended discontinuation of empiric antibiotics within 24 hours of prescribing. Demographics were collected. Clinical outcomes - duration of therapy, length of hospital stay (LOS), infection-related readmissions, and all-cause mortality - were compared between interventions accepted and rejected groups. Continuous data were analysed via unpaired Student's t-test. Categorical data were analysed using χ2 test or Fisher's exact test, as appropriate. RESULTS: The ASP team recommended 794 interventions (overall acceptance rate of 72.9%, 579 of 794). There were no significant between-group differences in underlying demographics, and Charlson comorbidity index score. However, the interventions acceptance group had significantly shorter duration of therapy by 2.61 days (2.72 ± 3.04 vs. 5.33 ± 2.54 days; P < 0.01) and LOS by 7.41 days (7.98 ± 13.14 vs. 15.39 ± 22.62 days; P < 0.01), with estimated cost savings of SGD10 817 per patient. There were no significant between-group differences in 14-day mortality and readmission rates. CONCLUSION: Prompt ASP interventions at Singapore General Hospital were associated with significant reductions in duration of therapy and LOS, with cost savings. It was demonstrated that it is safe to discontinue antibiotics within 24 hours of prescribing for patients with no evidence of bacterial infections.
BACKGROUND: Overprescribing antibiotics for patients with no bacterial infection is of growing global concern. It is important for timely Antimicrobial Stewardship Program (ASP) intervention to discontinue antibiotics for patients whose symptoms can be explained by non-infective causes, and without availability of bacterial cultures and susceptibilities reports. This study aimed to evaluate clinical outcomes and safety of early ASP review in these patients. METHODS: A retrospective review of the ASP database (January 2010 to December 2014) was conducted to identify patients for whom ASP recommended discontinuation of empiric antibiotics within 24 hours of prescribing. Demographics were collected. Clinical outcomes - duration of therapy, length of hospital stay (LOS), infection-related readmissions, and all-cause mortality - were compared between interventions accepted and rejected groups. Continuous data were analysed via unpaired Student's t-test. Categorical data were analysed using χ2 test or Fisher's exact test, as appropriate. RESULTS: The ASP team recommended 794 interventions (overall acceptance rate of 72.9%, 579 of 794). There were no significant between-group differences in underlying demographics, and Charlson comorbidity index score. However, the interventions acceptance group had significantly shorter duration of therapy by 2.61 days (2.72 ± 3.04 vs. 5.33 ± 2.54 days; P < 0.01) and LOS by 7.41 days (7.98 ± 13.14 vs. 15.39 ± 22.62 days; P < 0.01), with estimated cost savings of SGD10 817 per patient. There were no significant between-group differences in 14-day mortality and readmission rates. CONCLUSION: Prompt ASP interventions at Singapore General Hospital were associated with significant reductions in duration of therapy and LOS, with cost savings. It was demonstrated that it is safe to discontinue antibiotics within 24 hours of prescribing for patients with no evidence of bacterial infections.
Authors: Emma Pinet; P Sabatier; M P Fernandez-Gerlinger; A S Jannot; J L Mainardi; B Sabatier; T Caruba Journal: Eur J Clin Microbiol Infect Dis Date: 2022-06-25 Impact factor: 3.267
Authors: Shena Y C Lim; Yvonne P Zhou; Daphne Yii; De Zhi Chin; Kai Chee Hung; Lai Wei Lee; Jia Le Lim; Li Wen Loo; Narendran Koomanan; Nathalie Grace Chua; Yixin Liew; Benjamin P Z Cherng; Siew Yee Thien; Winnie H L Lee; Andrea L H Kwa; Shimin J Chung Journal: Antibiotics (Basel) Date: 2022-06-24
Authors: Glorijoy Shi En Tan; Hui Lin Tay; Sock Hoon Tan; Tau Hong Lee; Tat Ming Ng; David Chien Lye Journal: Adv Ther Date: 2020-08-07 Impact factor: 3.845