title: Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore.
abstract: We evaluated the impact of a prospective audit and feedback antimicrobial stewardship program (ASP) on antibiotic prescription and resistance trends in a hematology-oncology unit in a university hospital (National University Cancer Institute, Singapore [NCIS]). A prospective interrupted time-series study comprising 11-month pre-intervention (PIP) and intervention evaluation phases (IEP) flanking a one-month implementation phase was carried out. Outcome measures included defined daily dose per 100 (DDD/100) inpatient-days of ASP-audited and all antibiotics (encompassing audited and non-audited antibiotics), and the incidence-density of antibiotic-resistant microorganisms at the NCIS. Internal and external controls were DDD/100 inpatient-days of paracetamol at the NCIS and DDD/100 inpatient-days of antibiotics prescribed in the rest of the hospital. There were 580 ASP recommendations from 1,276 audits, with a mean monthly compliance of 86.9%. Significant reversal of prescription trends towards reduced prescription of audited (coefficient = -2.621; 95% confidence interval [CI]: -4.923, -0.319; p = 0.026) and all evaluated antibiotics (coefficient = -4.069; 95% CI: -8.075, -0.063; p = 0.046) was observed. No changes were seen for both internal and external controls, except for the reversal of prescription trends for cephalosporins hospital-wide. Antimicrobial resistance did not change over the time period of the study. Adverse outcomes-the majority unavoidable-occurred following 5.5% of accepted ASP recommendations. Safe and effective ASPs can be implemented in the complex setting of hematology-oncology inpatients.
authors.affiliation: Department of Pharmacy, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore.
authors.forename: C-L
authors.initials: CL
authors.lastname: Yeo
authors.forename: D S-G
authors.initials: DS
authors.lastname: Chan
authors.forename: A
authors.initials: A
authors.lastname: Earnest
authors.forename: T-S
authors.initials: TS
authors.lastname: Wu
authors.forename: S-F
authors.initials: SF
authors.lastname: Yeoh
authors.forename: R
authors.initials: R
authors.lastname: Lim
authors.forename: R
authors.initials: R
authors.lastname: Jureen
authors.forename: D
authors.initials: D
authors.lastname: Fisher
authors.forename: L-Y
authors.initials: LY
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data; D005335:Fever of Unknown Origin / Q000188:drug therapy*; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D008485:Medical Audit; D011446:Prospective Studies; D012846:Singapore
chemical_list: D000900:Anti-Bacterial Agents