Proceeding | By Syamhanin et. al.

Impact of antimicrobial stewardship in intensive care unit on antimicrobial consumption



Critical care patients are known to have higher risk for nosocomial infections which needs prompt and appropriate treatment with antimicrobial. Due to this, majority of intensive care unit (ICU) patients were prescribed with antimicrobial and thus, generate high antimicrobial consumption.


Therefore, there is a need for continuous monitoring of antimicrobial use in ICU to ensure that it is only prescribed for patients with true bacterial infections, to avoid unnecessary use. In Hospital Sungai Buloh, monitoring of antimicrobial consumption was initiated since 2007 as part of the national antimicrobial surveillance program under Ministry of Health. For year 2014, antimicrobial consumption in ICU of Hospital Sungai Buloh was higher than the upper limit of the national data for two antimicrobial groups, colistin and carbapenems.


Retrospective data collected for all ICU patients in 2014 revealed that only 56% of colistin was prescribed as targeted therapy. Upon further discussion among committee members of the Hospital Infection and Antibiotic Control Committee (HIACC), the intensivist and ICU pharmacist have agree to carried out a number of antimicrobial stewardship (AMS) activities, which include the following; weekly prospective audit and feedback for all patient treated with carbapenems and colistin, 72hour stop order for all patients on carbapenems and colistin and restricted use of colistin in intensive care unit.


All of these activities were carried from January 2015 onwards.


Impact of AMS program on antimicrobial consumption was studied by analysing data on DDD (Defined Daily Dose per 1000 patients bed days as defined by World Health Organization). Raw data were obtained from electronic records from eHIS (electronic Hospital Information System) and were later calculated using formatted spreadsheet.


Analysis was carried out by comparing mean from monthly DDD of respective antimicrobial from July-Dec 2014 (phase I) with Jan-Jun 2015 (phase II), using paired t-test (using SPSS software, version 16). A p value <0.05 is considered as significant. All patients on carbapenems and colistin were recorded and reviewed at 72hours after initiation.


Percentage of patients on empirical and definitive treatment of carbapenems and colistin were also recorded


Percentage of patients on empirical and definitive treatment of carbapenems and colistin were also recorded. Results Mean of DDD for both colistin and carbapenems in ICU have shown statistically significant reduction; from 298.64 in phase I to 94.36 in phase II (p=0.006) and from 350.78 in phase I to 244.44 in phase II(p=0.02), respectively. Empirical use of colistin has also shown a decline; from 44% (n=57) to 28.6% (n=8) and from 83% (n=94) to 59% (n=73) for carbapenems.


Correlation between antimicrobial consumption and resistance is well established. AMS program is an effective way to contain antimicrobial use by promoting judicious use of antimicrobial agents