Prospective Audit and Feedback of Targeted Antimicrobials Use at a Tertiary Care Hospital in the United Arab Emirates

Background/Objectives: Antimicrobial stewardship programs improve antimicrobial use and help combat antimicrobial resistance. The Infectious Disease Society of America's (IDSA) recommended core interventions include prospective audit and feedback along with formulary restriction and preauthorization. IDSA recommends any one of these interventions be implemented in acute care hospitals to improve antimicrobial stewardship. The objective of this project was to implement a prospective audit and feedback system using selected antimicrobials at a tertiary care hospital in the United Arab Emirates as the foundation to build an antimicrobial stewardship program. Results: A total of 497 patients met the inclusion and exclusion criteria during the study period; the post-intervention group had 260 patients, and the control group had 237 patients. After the implementation of the program, a total of 186 interventions were recommended, and 76% were accepted. The length of stay, length of therapy, and days of therapy were lower in the intervention group compared to the control group (p < 0.05). There was no statistically significant difference in clinical outcome measures (e.g., 30-day readmission, 30-day all-cause mortality, 30-day emergency visit with the same infection, and 60-day readmission). Methods: This single-center quasi-experimental research was conducted from August 2023 to July 2024. A pharmacist-led prospective audit and feedback system was initiated in February 2024 after review and approval of the medical staff, in addition to formulary restrictions. Data from patients receiving the selected antimicrobial before February 2024 were collected from their charts and related medical records without any intervention; this was used by our control group. After implementation, the hospital pharmacy's records were evaluated during the night shift to determine whether they met the inclusion criteria. The records of the eligible patients were then evaluated by the clinical pharmacist. In case of antimicrobial inappropriateness, feedback was provided to the prescriber. If the recommendation was not accepted, succeeding reviews and feedback were provided on subsequent days. The effectiveness of the intervention was measured using clinical and antibiotic use measures. Conclusions: Implementation of a pilot pharmacist-led antimicrobial stewardship program resulted in modification in antimicrobial use measures (i.e., defined daily doses of targeted antimicrobials and days of antimicrobial therapy) without an increase in length of stay or readmissions or mortality.

A Systematic Review of Pharmacist-Led Antimicrobial Stewardship Programs in Sub-Saharan Africa

BACKGROUND

The misuse of antibiotics contributes significantly to antimicrobial resistance (AMR). Higher treatment costs, longer hospital stays, and clinical failure can all result from AMR. According to projections, Africa and Asia will bear the heaviest burden of AMR-related mortalities in the coming years. Antimicrobial stewardship (AMS) programmes are therefore critical in mitigating the effects of AMR. Pharmacists may play an important role in such programmes, as seen in Europe and North America, but the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals are unknown. The purpose of this systematic review was to assess the impact, challenges, and opportunities of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan African hospitals.

METHODS

The Joanna Briggs Institute (JBI) guidelines were used to search for peer-reviewed pharmacist-led studies based in hospitals in Sub-Saharan Africa that were published in English between January 2015 and January 2021. The PubMed, Embase, and Ovid databases were used.

RESULTS

Education and training, audits and feedback, protocol development, and ward rounds were identified as primary components of pharmacist-led antimicrobial stewardship interventions in Sub-Saharan Africa. The pharmacist-led antimicrobial interventions improved adherence to guidelines and reduced inappropriate prescribing, but were hampered by a lack of laboratory and technological support, limited stewardship time, poor documentation, and a lack of guidelines and policies. Funding, mentorship, guidelines, accountability, continuous monitoring, feedback, multidisciplinary engagements, and collaborations were identified as critical in the implementation of pharmacist-led antimicrobial stewardship programmes.

CONCLUSIONS

These findings suggest that pharmacists in Sub-Saharan African hospitals can successfully lead antimicrobial stewardship programmes but their implementation is limited by lack of mentorship, accountability, continuous monitoring, feedback, collaborations, and poor funding.