TY  - THES
T1  - Antimicrobial consumption and resistance of restricted antibiotics and their economic impact in a level III government hospital
A1  - Abeleda, Mary Anne V.
A2  - Peña, Imelda G.
LA  - English
UL  - https://tuklas.up.edu.ph/Record/UP-1685675941131396774
AB  - Background: One of the world's most significant health problems is overuse of antibiotics that can lead to antibiotic resistance and economic burden to society. To address this, antimicrobial stewardship (AMS) program has been implemented globally to monitor restricted antibiotic consumption and prevent emergence of antibiotic resistance. Restricted antibiotics have been the focus of this study since these were used for the treatment of suspected serious or life-threatening infections that require an approval of infectious disease section fellow/consultant before dispensing to patients. This study compared the trends of restricted antibiotic consumption and antibiotic resistance of the top 10 isolated bacteria in the adult internal medical wards.
Methods: A retrospective review of pharmacy dispensing records was conducted in the adult internal medicine wards of a tertiary level teaching hospital in the Philippines between March 2019 to February 2020. Dispensing records of patients were analyzed to determine a one-year antibiotic consumption of restricted antibiotics using Defined Daily Dose (DDD) per 1000 patient-days. Antibiotic resistance was retrieved from the hospital's antibiogram. Correlations between antibiotic consumption and antibiotic resistance were analyzed using Pearson correlation coefficient. Economic impact of antibiotic resistance was evaluated using prevalence-based approach. Readmission frequencies and restricted antibiotic consumption of readmitted patients were evaluated. Outcomes were compared between ward 1 (with a unit dose pharmacist) and ward 3 (without a unit-dose pharmacist).
Results: The age group with the highest admissions was the 56-65-year-old group, accounting for 25% of patients (n = 1928); with males comprising more than half of admissions (55%). More than half of the male patients were prescribed with restricted antibiotics in the adult internal medicine wards. The top 10 isolated bacteria in the adult medicine wards include K. pneumoniae, A. baumannii, E. coli, P. aeruginosa, S. aureus, S. epidermidis, E. Faecium, S. hemolyticus, B. cepacia and E. cloacae. The decreasing trends of piperacillin-tazobactam consumption on both wards showed its decreased use among patients admitted in the adult medicine wards throughout the study period. Ceftazidime consumption in both wards were observed to continuously increase from quarter 1 to quarter 4. It was observed that levofloxacin was the most prescribed fluoroquinolone with the highest consumption recorded from Mar - May 2019 in ward 3 of 350 DDD/1000 PD as compared with ciprofloxacin which has the highest consumption (23.3 DDD/1000 PD) during the period June- Aug 2019 in ward1. Average antibiotic resistance rate of 4. baumannii was generally higher in ward 3 than in ward 1 across all restricted antibiotics. Antibiotic resistance of A. baumannii against ciprofloxacin, levofloxacin and piperacillin-tazobactam were statistically significantly different between the wards. In ward 1, ciprofloxacin consumption was strongly positively correlated with Escherichia coli (r = 0.90). In ward 3, a significantly moderately positive association was observed for ceftazidime consumption and A. baumannii resistance (r =0.61). positive correlation between piperacillin-tazobactam and E. coli resistance (r = 0.65) and a strong positive correlation between levofloxacin and P. aeruginosa resistance (r =0.71). Out of 1928 patients, 20.3 % were readmitted within the study period and 15.7% were readmitted in the hospital within 30 days. At least one readmission has an average consumption of Ertapenem, which is significantly different from the 11 other antibiotics in the study. Economic impact analysis showed that the costs of over-dispensed restricted antibiotics were Php 775,480.50 in ward 3 and Php 309,929.10 in ward 1. The cost of over dispensed antibiotics was significantly lower in ward 1 than in ward 3. Costs of hospital stay, and gram stain/culture sensitivity tests were lesser in ward 1 compared to ward 3. It was found that there were gaps in practice such as lack of detailed AMS training, lack of evaluation on AMS hospital protocol compliance and lack of drug information. To address these gaps, pharmacist-led interventions were proposed such as stability chart of restricted antibiotics, reconstitution and storage information of restricted antibiotics, and conduct of lectures on proper processing and dispensing.
Conclusion: Both wards showed decreasing trends in consumption of watch antibiotics except for ceftazidime which could mean that the antimicrobial stewardship program of the hospital is serving its purpose in eliminating unnecessary use of restricted antibiotics. The success of the AMS program has been based on the collective efforts of the AMS team with the implementation of hospital policies, such as the AMS program, across the different sites in the hospital in order to achieve optimum patient health outcomes. There was no significant difference in terms of resistance rates of the top 10 most commonly isolated bacteria. However, it was noted that the resistance rates of A. baumannii against ciprofloxacin, levofloxacin, and piperacillin-tazobactam were higher in ward 3 compared to ward I which makes infections very difficult to treat which may result to prolonged hospital stay, increased health-care costs and increased mortality rate. Pharmacists can contribute to the prevention of antibiotic resistance through reviewing antibiotic use of patients, monitoring trends of antibiotic use and ensuring compliance to the prescribed antibiotic regimen. Although there is no direct impact of pharmacist in terms of antibiotic consumption and antibiotic resistance, the role of the pharmacist was highlighted in contributing to possible cost savings of public health facilities which is vital for the institution to use these savings to fund other important activities to improve health care delivery.
CN  - LG 993.5 2023 P4 A24
KW  - Antibiotics. : Consumption. : Government hospitals.
KW  - Antibiotics. : Antimicrobial. : Resistance. : Philippines.
KW  - Antibiotics : Economic impact analysis. : Government Hospital.
ER  -