title: Antimicrobial stewardship program in a Malaysian district hospital: First year experience.
abstract: Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital.
  
  
  METHODS
  An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above.
  
  
  RESULTS
  Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004).
  
  
  CONCLUSIONS
  ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures.
authors.affiliation: Diana Yap Fui Sing, Master of Clinical Pharmacy (UKM). Hospital Enche' Besar Hajjah Khalsom, Jalan Kota Tinggi, 86000 Kluang, Johor, Malaysia.
authors.forename: Diana Yap Fui
authors.initials: DY
authors.lastname: Sing
authors.affiliation: Dr. Yang Liang Boo, MRCP (UK). Hospital Enche' Besar Hajjah Khalsom, Jalan Kota Tinggi, 86000 Kluang, Johor, Malaysia.
authors.forename: Yang Liang
authors.initials: YL
authors.lastname: Boo
authors.affiliation: Roshalina Mukhlis, Bachelor of Pharmacy (Hons) (UKM). Hospital Enche' Besar Hajjah Khalsom, Jalan Kota Tinggi, 86000 Kluang, Johor, Malaysia.
authors.forename: Roshalina
authors.initials: R
authors.lastname: Mukhlis
authors.affiliation: Dr. Pek Woon Chin, MRCP (UK). Hospital Enche' Besar Hajjah Khalsom, Jalan Kota Tinggi, 86000 Kluang, Johor, Malaysia.
authors.forename: Pek Woon
authors.initials: PW
authors.lastname: Chin
authors.affiliation: Dr. Fan Kee Hoo, MRCP (UK). Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
authors.forename: Fan Kee
authors.initials: FK
authors.lastname: Hoo
keywords: Anti-Infective agents; Antimicrobial stewardship; Drug resistance; Malaysia; Rural hospital