Proceeding | By Syamhanin et. al.

Impact of antimicrobial stewardship activities in tertiary hospital, Malaysia

PRESENTED AT | 16th APCCMI, Melbourne, Australia


A multi-disciplinary antimicrobial stewardship (AMS) team, consist of Infectious Disease Physician, Clinical Microbiologist and Clinical Pharmacist, was formed in Sungai Buloh Hospital in November 2014. From January 2015 onwards, the team has carried out a number of AMS activities, which include the following :

  1. Weekly prospective audit and feedback for all patient treated with carbapenem, piperacillin/tazobactam, cefepime and ceftriaxone in medical and neurosurgical ward

  2. 72-hour stop order for all carbapenems prescription 

  3. Restricted use of colistin in Intensive Care Unit (ICU). The main objective of this study is to evaluate the impact of AMS in antimicrobial consumption before and after the AMS program.


Impact of AMS program on antimicrobial consumption was studied by analyzing data on DDD (Defined Daily Dose per 1000 patient bed days as defined by World Health Organization).


Raw data were obtained 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 in year 2014 (phase 1) with year 2015 (phase 2) using paired t-test (using SPSS software, version 16).


Data were analyzed for: 

1)Colistin 2)Carbapenem 3)Ceftriaxone 4)Cefepime and 5)Piperacillin/tazobactam

for the respective wad involved in AMS program. A p value <0.05 is considered as significant.


DDD for total colistin have shown statistical difference, from 23.13 in 2014 to 11.32 in 2015 (p = 0.001). Significant impact was also clearly shown in antimicrobial utilization of the respective department that were involved in AMS activities. Colistin usage in ICU have drastically reduced from 235.99 in 2014 to 106.58 in 2015 (p=0.001), cefepime in medical department shows significant reduction, from 63.90 to 39.27 (p=0.03).


All the department involves in AMS program in this study were among the high user of the measured antimicrobials.However, significant increase was observed in cefepime for neurosurgical department , this might due to the effect of `squeezing the antibiotic balloon’ 1.


This study has shown that, by targeting specific disciplines, through good collaboration between the AMS team and the primary team; significant reduction on antimicrobial consumption can be achieved. Even though the overall data only shows significant difference in colistin; analysis data of the specific discipline does show significant reduction in certain antimicrobials.


Reduction was also observed in overall of other antimicrobials, except for cefepime; which shows slight increase, although it is not statistically significant. Correlation between antimicrobial consumption and resistance is well established2-3.


AMS program is an effective way to contain antimicrobial use by promoting judicious use of antimicrobial; which will eventually may able to control the emergence and spread of antimicrobial resistance 4-6. Positive outcome from AMS activities as shown in this study would certainly encourage our AMS team to promote our activities to other discipline in our hospital