title: Introducing an antibiotic stewardship program in a humanitarian surgical hospital.
abstract: Antibiotic stewardship program (ASP) implementation in humanitarian settings is a new endeavor. Doctors Without Borders/Médecins Sans Frontières introduced an ASP within a hospital in Amman, Jordan, where patients from Iraq, Syria, and Yemen with chronic, often multidrug-resistant, infections related to war are managed. Antibiotics were reviewed, and real-time recommendations were made to optimize choice, dose, duration, and route by a small team. Over the first year of implementation, acceptance of the ASP's recommendations improved. When compared with the year prior to implementation, antibiotic cost in 2014 declined considerably from approximately $252,077 (average, $21,006/month) to <$159,948 ($13,329/month), and a reduction in use of broad-spectrum agents was observed. An ASP in a humanitarian surgical hospital proved acceptable and effective, reducing antibiotic expenditures and use of broad-spectrum agents.
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Naina
authors.initials: N
authors.lastname: Bhalla
authors.affiliation: Doctors Without Borders, Amman, Jordan.
authors.forename: Nagham
authors.initials: N
authors.lastname: Hussein
authors.affiliation: Doctors Without Borders, Amman, Jordan.
authors.forename: Maha
authors.initials: M
authors.lastname: Atari
authors.affiliation: Doctors Without Borders, Amman, Jordan.
authors.forename: Rasheed M
authors.initials: RM
authors.lastname: Fakhri
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lepora
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Walsh
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.affiliation: Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA. Electronic address: rmurphy@labiomed.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Murphy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003141:Communicable Diseases / Q000188:drug therapy*; D004363:Drug Utilization / Q000592:standards*; D006761:Hospitals; D006801:Humans; D007597:Jordan
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship; antibiotic resistance; bacterial infections; chronic osteomyelitis; developing countries; low- and middle-income countries; reconstructive surgery; resource-limited settings; trauma surgery; war surgery