The Impact of New Antibiotic Stewardship Program and Vancomycin Susceptibility Pattern of Group D Enterococci: Experience in the Specialized Neurological Hospital

Abstract

 Background: The Antibiotic Stewardship Program (ASP) is an important process to reduce rate of drugresistance of pathogens in hospitals. In the past, we used retrospective audit process to monitor antibiotics usage, before providing feedback for specific usage suggestion. We collected broad-spectrum antibiotics usage data through antibiotic request forms and Defined Daily Dose (DDD) records. Recent data from antimicrobial susceptibility pattern report shown that the vancomycin usage significantly increased while the antimicrobial susceptibility pattern of group D enterococci decreased from 100 percent to 96 percent. These undesirable trends could lead to higher rate of drug-resistance of pathogens in our hospital.Objective: To study the alternative ASP intervention that can reduce vancomycin usage and improve antimicrobial susceptibility of group D enterococci to the vancomycin.Method: This study was a descriptive observation study. We collected data from 442 admitted patients who filled the request forms to use vancomycin during January 1st, 2014 to December 31st, 2017. The 215 patients who received vancomycin during 2014-2015 were treated under retrospective audit and feedback (previous ASP). The remaining 227 patients who received vancomycin during 2016-2017 were implemented the antibiotics automatic timeout and pre-authorized intervention (new / alternative ASP). With this new ASP, the vancomycin usage will be automatically stopped after 72 hours of initial use and will require pre-authorization from internal medicine staffs to continue the usage afterward. After that, we evaluated impact of this new ASP by comparing changes of the vancomycin usage and the antimicrobial susceptibility pattern of gram-positive resistant bacteria from microbiological laboratories annual reports.Result: After implementing the new antibiotics automatic timeout and pre-authorized intervention, the DDD decreases from 32.1 per 1,000 inpatient-day in 2014 and 44.5 per 1,000 inpatient-day in 2015 to 34.4 per 1,000 inpatient-day in 2016 and 39.3 per 1,000 inpatient-day in 2017. Meanwhile, the antimicrobial susceptibility of group D enterococci to vancomycin improves from 96 percent in 2014 and 95 percent in 2015 to 100 percent in both 2016 and 2017.Conclusion: This new ASP intervention which combines the vancomycin automatic timeout with pre-authorization (after the timeout) is proven to be more effective method to control vancomycin resistant group D enterococci.