ASPs optimize antibiotic use, achieve best outcomes, minimize adverse effects, reduce costs and limit pressures contributing to the emergence AMR. SHEA, IDSA and PIDS recommend mandatory implementation of ASP throughout healthcare institutions. The objective was to describe antimicrobial stewardship related lessons learnt in light of interventions made during the first year of implementation of an ASP at the Princess Margaret Hospital in Nassau, Bahamas.
Prospective audit of antimicrobial use with feedback and intervention was the strategy employed by antimicrobial stewardship between November 2016-September 2017. The clinical pharmacist monitored patients on adult medical, surgical wards and critical care unit for the use of carbapenems, vancomycin, antipseudomonal cephalosporins, piperacillin-tazobactam, fluoroquinolones, intravenous fluconazole, amphotericin B and acyclovir. Antimicrobial stewardship rounds were done by the ID physicians and clinical pharmacist in order to make recommendations to the clinical team. These included de-escalation, escalation of antimicrobial therapy, infectious diseases consultation recommendations and pharmacokinetic dosing. Acceptability of prospective and feedback recommendations, time to intervention and patients socio-demographics were also obtained.
88 patients were seen during this period in which 52 (59.1%) were females and 36 (40.9%) males. 102 recommendations were made by the antimicrobial stewardship team. Of these, 53 (52%) patient-interventions were made. 49 (48%) patients were reviewed and left on therapy. Antimicrobial stewardship interventions included de-escalation 22 (41.5%), ID consultation 21 (39.6%), escalation 7 (13.2%) and pharmacokinetic dosing 3 (5.7%). 16 (73%) de-escalation of therapy was accepted and 6 (27%) not accepted. The mean number of days that antimicrobials were administered before intervention was 3 (range: 0-18 days).
An ASP is a feasible strategy to reduce emerging antimicrobial resistance in The Bahamas.
Implementing an ASP in The Bahamas is practical and may result in significant de-escalation of antimicrobial therapy.
The way forward is to formalize ASP into a sustainable, structured program within the institution.
M. A. C. Frankson, None