Impact of a multidisciplinary antimicrobial stewardship program on antibiotic utilization and clinical outcomes at a tertiary hospital in Saudi Arabia: a quasi-experimental study

ABSTRACT

Background

This study aims to assess the impact of a multidisciplinary antimicrobial stewardship program (ASP) intervention on various metrics.

Methods

A quasi-experimental study was performed on non-ICU patients for whom a restricted antibiotic was ordered. In September 2020, a prospective audit and feedback was implemented involving infectious disease clinical pharmacists, utilization of electronic resources, and improved documentation. Outcomes included defined daily dose and days of therapy per 100-patient days (DDD/100PD and DOT/100PD) and patient clinical outcomes.

Results

402 episodes were evaluated for 167 and 190 unique patients in the pre- and post-intervention phases, respectively. DDD/100PD and DOT/100PD were lower in the post-phase than in the pre-phase (1.75 vs. 2.54 and 16.13 vs. 44.93). Antibiotic de-escalation and clinical cure rates were significantly higher in the post-phase than in the pre-phase (62% vs. 40.6% and 83.5% vs. 65.8%; P < 0.001 for both comparisons). Hospital and ICU stays were significantly shorter in the post-phase (14 vs. 22 and 3 vs. 9, respectively; P < 0.001 for both comparisons). In-hospital mortality and 30-day readmission rates were lower in the post-phase (13% vs. 20.8%; P = 0.037 and 20.5% vs. 33.8%; P = 0.003, respectively).

Conclusion

The implemented multidisciplinary ASP intervention was associated with a significant improvement in antibiotic utilization and patient clinical outcomes.

KEYWORDS:

• Antimicrobial stewardship
• antibiotic stewardship
• antibiotic utilization
• clinical outcomes
• pharmacist

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We would like to thank the Hospital Information System team and hospital pharmacy for their assistance in extracting data on antimicrobial consumption. This study was presented as a poster at the Infectious Diseased Society of America annual meeting, IDWeek, in Boston, MA, 2023 (poster no. 1270).

Ethics statement

The study protocol was approved by the Research Committee of the Unit of Biomedical Ethics, of Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (reference no. 15–22).

Author contribution statement

KAS, SAA, and MOB: Data curation, Investigation, Writing – original draft. RB: Data acquisition. KE, RK, RB: Writing – review & editing. AKT: Conceptualization, Methodology, Formal analysis, Writing – review & editing.

Additional information

Funding

This paper was not funded.