The System Development of the Antimicrobial Stewardship Program for Antimicrobial Resistance Prevention at Loei Hospital
Keywords:
System development, Antimicrobial stewardship, Antimicrobial resistanceAbstract
Background: Antimicrobial resistance is an important public health problem at both the national and global levels. It is also a major problem of Loie hospital that the rate of antimicrobial resistance is likely to increase continuously.
Objective: To develop the antimicrobial stewardship program (ASP) and evaluate the use of ASP for antimicrobial resistance prevention at Loei Hospital.
Method: Research and Development design and evaluation with quasi-experimental research/ simple interrupted time series (ITS). Sample was time series data included 24-month data during January 2018 - December 2019, which divided into 14 months pre-ASP system period and 10 months post-ASP system period. The research tools consisted of antimicrobial prescription forms, monthly data record forms and the microbiological laboratory system management program (MLAB program) recorded the sensitivity and resistance of bacteria. Data were collected including the amount of drug use (defined daily doses: DDDs), the expenditure of six ATB: meropenem, levofloxacin, sulperazone, colistin, vancomycin and fosfomycin as well as antimicrobial resistance infection rates were collected. Data were analyzed using statistics including percentage, mean, Pearson’ Correlation Coefficient, Spearman correlation and segmented regression of ITS.
Results: The implement of developed-ASP system reduced the amount of use and expenditure of all antibiotics except fosfomycin. The amount of use of 3 antibiotics correlated significantly with bacterial resistance (p<0.05) that were meropenem (A.baumannii r=0.576, E.Coli r=0.425), levofloxacin (P.aeruginosa r=0.439, K.Pneumoniae r=0.426) and sulperazone (P.aeruginosa r=0.672). Importantly, analysis with segmented regression analysis after the ASP system, the decrease in the amount of use and the expenditure was indicated only 2 antibiotics: sulperazone (-0.708 DDDs/ -16,074 baht) and meropenem (-2.305 DDDs/ -87,725 baht). However, antimicrobial resistance infection rate was unchanged.
Conclusion: The ASP system was effective; however, it should integrate the variety of method to promote the appropriate use of antibiotics for preventing and reducing antimicrobial resistance infection.
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