![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
This study reports the effect of implementing an antibiotic stewardship program (ASP) based on the “handshake” strategy for 2 years on multiple endpoints compared with that in a preceding period when an antimicrobial restriction policy was only applied in the absence of a complete program in a tertiary-care Lebanese hospital. The studied endpoints were broad-spectrum antibiotic consumption, antibiotic expenditure, nosocomial bacteremia incidence rate, and patient outcome.
An interrupted time series analysis was undertaken to assess the changes in the trend (ΔT) and level (ΔL) of the aforementioned endpoints among adult inpatients before (October 2013 to September 2015) and after the introduction of the ASP (October 2016 to September 2018).
After the implementation of the “handshake” ASP, marked changes were observed in the consumption of broad-spectrum antibiotics. The mean use density levels for imipenem and meropenem decreased by 13.72% (P = 0.017), coupled with a decreasing rate of prescription (ΔT = −24.83 defined daily dose [DDD]/1,000 patient days [PD]/month; P = 0.02). Tigecycline use significantly decreased in level by 69.19% (P < 0.0001) and in trend (ΔT = −25.63 DDD/1,000 PD/month; P < 0.0001). A reduction in the use of colistin was also documented but did not reach statistical significance (ΔL = −8.71%, P = 0.56; ΔT = −5.51 DDD/1,000 PD/month = −5.5; P = 0.67). Antibiotic costs decreased by 24.6% after ASP implementation (P < 0.0001), and there was a distinct change from an increasing rate to a decreasing rate of expenditure (ΔT = −12.19 US dollars/PD/month; P = 0.002). The incidence rate of nosocomial bacteremia caused by carbapenem-resistant gram-negative bacteria (CRGNB) decreased by 34.84% (P = 0.13) coupled with a decreasing trend (ΔT = −0.23 cases/1,000 PD/month, P = 0.08). Specifically, a noticeable reduction in the incidence rate of bacteremia due to carbapenem-resistant Acinetobacter baumannii was documented (ΔL = −54.34%, P = 0.01; ΔT = −0.24 cases/1000 PD/month, P = 0.01). Regarding patient outcome, all-cause mortality rates did not increase in level or in rate (ΔL = −3.55%, P = 0.59; ΔT = −0.29 deaths/1000 PD/month, P = 0.6). The length of stay and 7-day readmission rate remained stable between the two periods.
In conclusion, the “handshake” ASP succeeded in controlling the prescription rates of antibiotics and in decreasing the nosocomial bacteremia rates caused by CRGNB without compromising patient outcome in our facility. It also had an economic effect in reducing antibiotic costs compared with the previous restriction policy on antimicrobial dispensing.
Disclosure statement
The authors declare no conflict of interest.
Additional information
Funding
Notes on contributors
Rima Moghnieh
Rima Moghnieh, MD, FRCP. Prof. Rima Moghnieh, an infectious disease specialist and researcher, has been practicing medicine in Lebanon since 1996. She has assumed leadership positions in Infection Prevention and Control and in Antimicrobial Stewardship in several tertiary care hospitals in Lebanon. She is the former president of the Lebanese Society for Infectious Diseases and Clinical Microbiology (LSIDCM). Since 2018, she has been appointed by the World Health Organization as a part-time consultant to develop the National Action Plan for the control of antimicrobial resistance in several Middle Eastern countries including Lebanon, Syria, United Arab Emirates, Libya, and Tunisia. Dr. Moghnieh has co-authored over 30 publications in peer-reviewed journals. Among her scholarly work is her leadership in publishing clinical guidelines with the LSIDCM members for management of community-acquired bacterial pneumonia in adults, febrile neutropenia in the context of antimicrobial resistance, urinary tract infections and complicated intra-abdominal infections. Dr. Moghnieh's research interest is pluridisciplinary where she has principally co-authored several papers in various fields of Infectious Diseases, Infection Prevention and Control in hospitals, and Antimicrobial Stewardship.
Lyn Awad
Lyn Awad, BS Pharm. Lyn Awad earned her Bachelor of Science degree in Pharmaceutical Sciences from The Lebanese American University, Lebanon. She served as an Antimicrobial Stewardship Pharmacist at Makassed General Hospital, Lebanon from 2016 to 2018. She is a coauthor of several original research articles and narrative reviews of literature in the field of Infectious Diseases and Infection Prevention in hospitals in peer-reviewed journals.
Dania Abdallah
Dr. Dania Abdallah, PharmD. Dr. Abdallah obtained her Doctor's Degree in Clinical Pharmacy from the School of Pharmacy, Beirut Arab University, Lebanon in 2010. She serves as a hospital pharmacist and clinical research assistant at Makassed General Hospital. Dr. Abdallah has coauthored over 20 publications in the field of Infectious Diseases in several reputable peer-reviewed journals. Her current research focuses on antimicrobial stewardship and infection prevention strategies in acute care hospitals.
Marwa Jadayel
Marwa Jadayel, BS Pharm. Marwa Jadayel received her Bachelor of Science degree in Pharmacy from Beirut Arab University, Lebanon in 2018. She practiced as a community pharmacist from 2018 to 2019. She is actually a clinical research assistant in the field of Infectious Diseases since 2019. She is preparing her Master's degree in Clinical research and Epidemiology from the Lebanese University, Lebanon.
Loubna Sinno
Loubna Sinno, MPH. Loubna Sinno received her Bachelor of Science in Biology followed by a Masters in Public Health from the American University of Beirut, Lebanon. She was appointed as a Research Coordinator at Makassed General Hospital, Beirut, Lebanon. Through her work, she has been involved in supervising research projects as well as helping in analyses and manuscript writing. Her research interest is generally in clinical research especially in the obstetrics & gynecology and internal medicine fields.
Hani Tamim
Hani Tamim, PhD. Dr. Tamim is Associate professor at Department of Internal Medicine, American Univeristy of Beirut, Lebanon. He is Director of the Biostatistics Unit, Clinical Research Institute, the Fellowship and Residency Research Program, and the Medical Research Volunteer Program at the American University of Beirut Medical Center, Lebanon. Dr. Tamim coauthored several publications in the field of Clinical Medicine in reputed peer-reviewed journals.
Tamima Jisr
Tamima Jisr Shaar, MD. Dr. Jisr Shaar is Associate Professor of Laboratory Medicine at Beirut Arab University, Lebanon. She is the Chairperson of Laboratory Medicine, transfusion Medicine, Cellular therapy Department at Makassed General Hospital, Beirut, Lebanon since 1977. She has coauthored several research articles in peer-reviewed journals and participated in several clinical trials. She is a board member of the Lebanese National Council for scientific research since 1992 till now. She was decorated as Officer of the Lebanese National Order of the Cedar.
Salam El-Hassan
Salam El-Hassan is a Registered Nurse and she received her Bachelor of Science in Nursing from Makassed University of Beirut, Lebanon. She has a Masters Degree in Healthcare Quality and Management from the Lebanese University, Lebanon. She is currently a Quality Improvement Supervisor at Makassed General Hospital, Lebanon. Her interest in research is in the field of infection prevention and control bundles in acute care hospitals.
Rawad Lakkis
Rawad Lakkis is a student at the Faculty of Arts and Sciences at the American University of Beirut, Lebanon since 2019. He is interested in clinical research and is currently helping in data management and analysis of several ongoing clinical research projects.
Rima Dabbagh
Dr. Rima Dabbagh, MD. Dr. Dabbagh earned her Medical Doctor Degree in 2015 at Beirut Arab University, Lebanon. She completed her Residency in Internal Medicine at Makassed General Hospital affiliated with The American University of Beirut, Lebanon. She is currently an active Fellow in Gastroenterology at Makassed General Hospital. Her area of research interest includes Helicobacter pylori and associated gastric cancer, inflammatory bowel disease and chronic pancreatitis management.
Abdul Rahman Bizri
Abdul Rahman Bizri, MD, MSc, DLSHTM. Dr. Bizri is a Consultant in Internal Medicine and Infectious Diseases at the American University of Beirut, Lebanon. He is Assistant Chairperson for Clinical Affairs and Director of Quality and Compliance Program at the American University of Beirut Medical Center, Lebanon. He is an Affiliate at the Conflict Medicine Program – Global Health Institution. He is Chairperson of the Lebanese National Certification Committee for eradication of Poliomyelitis.