title: A multidisciplinary antimicrobial stewardship programme safely decreases the duration of broad-spectrum antibiotic prescription in Singaporean adult renal patients.
abstract: Patients with chronic kidney disease have increased risk of infections. Thus, physicians may favour prolonged broad-spectrum antibiotic use. Studies focused on antimicrobial stewardship programmes (ASPs) in renal patients are currently lacking. Here we describe the role of a multidisciplinary ASP and the impact of ASP interventions in renal patients. A multidisciplinary ASP was initiated at a tertiary hospital in Singapore. Patients prescribed broad-spectrum parenteral antibiotics were identified daily and were subjected to prospective review with immediate concurrent feedback. ASP data from January 2010 to December 2011 were analysed for all renal patients. Outcome measures included the duration and appropriateness of antibiotics, intervention acceptance rates, cost savings and safety outcomes. A total of 2084 antibiotic courses were reviewed, of which 24% were inappropriate, with meropenem most commonly prescribed inappropriately (31.0%). The commonest reasons for inappropriate use were wrong choice (51.0%) and wrong duration (21.4%). In total, 634 recommendations were made, with high acceptance rates (73.3%). Recommendations to discontinue antibiotics (33.4%) and to optimise doses (17.2%) comprised the bulk of ASP work. A mean reduction of -1.28 days of antibiotic use was observed among patients with interventions accepted versus those rejected (P<0.001), with direct cost savings of SGD$90,045. No difference in 30-day mortality (P=0.91) was observed between the accepted and rejected intervention groups. In conclusion, a multidisciplinary ASP resulted in a shorter duration of antibiotic use without compromising safety in renal patients. Continued effort is needed to produce a long-term impact on antibiotic prescription and resistance.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Yiying
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Pui Ying
authors.initials: PY
authors.lastname: Shek
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Teo
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Sarah S L
authors.initials: SS
authors.lastname: Tang
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Winnie
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Liew
authors.affiliation: Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore.
authors.forename: Piotr
authors.initials: P
authors.lastname: Chlebicki
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; Emerging Infectious Diseases, Duke-National University of Singapore Graduate Medical School, Singapore 169547, Singapore; Pharmacy, Faculty of Science, National University of Singapore, Singapore 117546, Singapore. Electronic address: andrea.kwa.l.h@sgh.com.sg.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Kwa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001424:Bacterial Infections / Q000188:drug therapy*; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D011307:Drug Prescriptions / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012846:Singapore; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship programme; Appropriate antibiotic use; Chronic kidney disease