Effectiveness of antimicrobial stewardship in a middle tier hospital – A quasi-experimental retrospective study

Abstract

Background: Antimicrobial Stewardship (AMS) is a framework that restricts antimicrobial use was introduced in our hospital in October  2019 and its effect had not been evaluated.

Objective: To determine the effect of AMS in Karatina Sub-County Hospital.

Methods: A quasi-experimental retrospective study looking at antimicrobia utilization before and after AMS implementation in a Sub- County hospital records department. Census sampling was done for; all inpatients on antibiotics; and for outpatients seen on dates of the  specific months. Data were abstracted on: type of antibiotic, dose, frequency, indication, adherence to WHO-AWaRe categorization and prescriber cadre. Data were analyzed using R software.

Results: For the outpatient 243 (45.7%) prescriptions did not fulfil AWaRe categorization in the pre-AMS period reducing to 127 (37.8%) in the post AMS period p<0.05. Prescriptions with antibiotics reduced from  70.4% to 35.7% and prescriptions written by interns from 40.9% to 15.7%. For the inpatient, initially 78 (22.3%) prescriptions did not fulfil  AWaRe categorization, but this reduced to 76 (19.9%). Prescriptions with antibiotics were reduced from 47.6% to 40.8% and specialist  prescriptions increased from 0.7% to 11.9%. Defined daily doses of antibiotics cumulatively increased between the two periods in both  departments but reduced for amoxicillin, cefixime, cefuroxime, doxycycline and ceftriaxone.

Conclusion: There was statistically  significant reduction in antibiotic use after the institution of AMS.