title: Antimicrobial stewardship program implementation in a medical intensive care unit at a tertiary care hospital in Saudi Arabia.
abstract: OBJECTIVE
  Antimicrobial stewardship programs (ASPs) have shown to prevent the emergence of antimicrobial resistance associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the prescribing appropriateness rate of the empirical antibiotic therapy before and after the ASP implementation in a tertiary care hospital. Secondary objectives include the rate of Clostridium difficile-associated diarrhea (CDAD), physicians' acceptance rate, patient's intensive care unit (ICU) course, total utilization using defined daily dose, and total direct cost of antibiotics.
  
  
  METHODS
  This is a comparative, historically controlled study. Adult medical ICU patients were enrolled in a prospective fashion under the active ASP arm and compared with historical patients who were admitted to the same unit before the ASP implementation. This study was approved by the institutional review board, and the need for informed consent was waived because the interventions and recommendations were evidence based and considered the standard of care. The study was conducted at KFSHRC, Riyadh.
  
  
  METHODS
  Adult medical ICU patients were enrolled under the active ASP arm if they were on any of the 5 targeted antibiotics (piperacillin/tazobactam, imipenem/cilastatin, meropenem, vancomycin, tigecycline), and had no official infectious disease consultation. The interventions were conducted via prospective audit and feedback.
  
  
  RESULTS
  A total of 73 subjects were recruited, 49 in historical control and 24 in the active arm. The appropriateness of empirical antibiotics was improved from 30.6% (15/49) in the historical control arm to 100% (24/24) in the proactive ASP arm (P value < .05). For the ASP group, initially 79.1% (19/24) of the antibiotic uses were inappropriate and diminished by ASPs to 0% on the recommendations implementation. A total of 27 interventions were made with an acceptance rate of 96.3%. The rate of CDAD did not differ between the groups. A reduction in antibiotics utilization and direct cost were also noticed in the ASP arm.
  
  
  CONCLUSIONS
  A proactive ASP is a vital approach in optimizing the appropriate empirical antibiotics utilization in an ICU setting in tertiary care hospitals. This study highlights the importance of such a program and may serve as a foundation for further ASP initiatives particularly in our region.
authors.forename: Marwa R
authors.initials: MR
authors.lastname: Amer
authors.forename: Nathem S
authors.initials: NS
authors.lastname: Akhras
authors.forename: Wafeeq A
authors.initials: WA
authors.lastname: Mahmood
authors.affiliation: Dr. Abdulrazaq S. Al-Jazairi, Head, Medical/Critical Pharmacy Department,, Division of Pharmacy Services,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354, MBC-11, Riyadh 11211,, Saudi Arabia, T: +966-11-4427603, F: +966-11-4427608, ajazairi@kfshrc.edu.sa.
authors.forename: Abdulrazaq S
authors.initials: AS
authors.lastname: Al-Jazairi
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology*; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology; D016527:Drug Costs; D024881:Drug Resistance, Bacterial; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012529:Saudi Arabia; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents