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The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital

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Abstract

Inappropriate antibiotic use contributes to antimicrobial resistance. Multi-faceted antimicrobial stewardship programmes (ASPs) are recommended for sustainable changes in prescribing practices. A multi-disciplinary ASP was established in October 2008 and piloted in the Departments of General Surgery, Renal Medicine and Endocrinology sequentially. To improve the quality of patient care via optimising the (1) choice, (2) dose, (3) route and (4) duration of antibiotics, a “whole-system” approach incorporating prospective review with immediate concurrent feedback (ICF), prescriber education (public or individualised), de-escalation of therapy, dose optimisation and parenteral-to-oral conversion, while recognising the autonomy of primary prescribers, was adopted. The audited department received a quarterly outcomes report and any common unaccepted practices would be addressed. Outcomes were analysed for 12 months post-ASP implementation. A total of 1,535 antibiotic prescriptions were reviewed. Antimicrobial use in 376 (24.5%) prescriptions was inappropriate. Of 596 interventions made, 70.2% were accepted. A reduction in audited antibiotics consumption resulted in acquisition cost savings of S$198,575 for the hospital. Patients’ cost-savings attributable to ASP-initiated interventions were $91,194. The overall all-cause mortality rate and median monthly inpatient-days pre- and post-intervention remained stable. A “whole-system” ASP was effective in optimising antibiotic use in our hospital, without compromising clinical outcomes.

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Acknowledgements

The authors would like to thank Ms Yixin Liew, Ms Rachel Ong, Ms Yiying Cai, Ms Sarah Tang, Ms Cheryl Lim and Ms Noor'ain Bte Gulambas for their assistance in running the antimicrobial stewardship programme; and the physicians of the participating departments for their support of the programme. The results included in this manuscript were presented, in part, as an oral paper at the 12th Western Pacific Congress on Chemotherapy and Infectious Diseases, Singapore, 4 December 2010.

Transparency declarations

This work was supported by a grant from the SingHealth Foundation (SHF/IIC003/2009; $50,000). Dr. Andrea Kwa Lay Hoon and Ms. Winnie Lee have received funding for research from Johnson & Johnson (Janssen-Cilag), Merck Sharp & Dohme (I.A.) Corp and Pfizer.

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Authors and Affiliations

  1. Department of Pharmacy, Singapore General Hospital, Blk 8, Level 2, Outram Road, 169608, Singapore, Singapore

    J. Teo, A. L. H. Kwa & W. Lee

  2. Department of Infectious Diseases, Singapore General Hospital, Outram Road, 169608, Singapore, Singapore

    J. Loh & M. P. Chlebicki

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  1. J. Teo
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  2. A. L. H. Kwa
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  3. J. Loh
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  4. M. P. Chlebicki
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  5. W. Lee
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Correspondence to W. Lee.

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Teo, J., Kwa, A.L.H., Loh, J. et al. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital. Eur J Clin Microbiol Infect Dis 31, 947–955 (2012). https://doi.org/10.1007/s10096-011-1391-y

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  • DOI: https://doi.org/10.1007/s10096-011-1391-y

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