Introducing the Antimicrobial Therapy Program and the Antibiotic Stewardship team in Healthcare Institutions according to the experience of the first antibiotic stewardship team in the General Hospital "Dr. T. Bardek "Koprivnica
Darija Kuruc Poje, univ.mag.pharm., clinical pharmacist (General Hospital "Dr. T. Bardek "Koprivnica)
Mr.sc. Vesna Mađarić, MD, infectologist (General Hospital "Dr. T. Bardek "Koprivnica)
Vlatka Janeš Poje, MD, microbiologist (Department of Public Health Koprivnica County)
From the 1st September 2017 at the General Hospital "Dr. Tomislav Bardek", the project of the Antibiotic Stewardship team (A-team) implementation was initiated by infectologists, microbiologists and clinical pharmacist. The aim was rationalizing the treatment of patients with the most severe infections. The A-team goal is to optimize clinical outcomes by minimizing adverse effects of antibiotics, increasing susceptibility to targeted antibiotics and reducing costs. In recent years, there has been an increase in the consumption of antibiotics used as the last line of treatment when other antibiotics no longer work (the so-called antibiotic reserve, AR), which is why we started with the pilot project at our institution. The pilot proved to be extremely successful, which was the reason of presenting the results of the project to the Ministry of Health and all the heads of county and general hospitals on 25th of April 2018. Our hospital, also organized a professional meeting on 15th of June 2018 for all clinics, county, general and special hospitals, i.e. directors and their future A-teams, where, with distinguished guest lecturers (from the University Hospital Centre Zagreb, the University Hospital for Infectious Disease Dr. Fran Mihaljević, Zagreb and the Faculty of Pharmacy and Biochemistry, University of Zagreb), we shared our experiences and ways of implementation in hospitals.
Antimicrobial resistance poses an increasing problem by endangering the health and safety of patients in all health environments. It is estimated that by 2050 mortality from antimicrobial resistance will amount to 10 million, which will exceed 8.2 million cancer deaths and 1.5 million diabetes deaths. Almost half of the prescribed antibiotics in hospitals are unnecessary or inappropriate, as research showed. Appropriate antimicrobial therapy dose no longer include, a simple selection of empirical or therapeutic antibiotics that will suitably act on the causative agent in a suitable patient, but involves a set of complex procedures for which the entire Antibiotic Stewardship team (A-team) is required. A particular problem is the antibiotics used in the last line of treatment when other antibiotics no longer function (the so-called antibiotic reserve, AR) whose quantity has increased significantly in recent years. Despite evidence of the benefits of A-team team implementation, it has still not been recognized and applied in Croatia. As a consequence, the A-team implementation project was started in the General Hospital "Dr. Tomislav Bardek "Koprivnica on 1st September 2017.
To show through the multidisciplinary collaboration of infectologists - physician, microbiologist -physician and clinical pharmacist, as compulsory A-team members, who implement and coordinate interventions aimed at the proper application of antimicrobial therapy and the ability to improve treatment outcomes.
Using a prospective audit and feedback strategy which means an empirically applied antibiotic evaluation and audit with intervention and feedback to a clinician, the clinical pharmacist validates and issues AR based on the interpretation of the findings of the microbiologist and the clinical findings of the infectologist.
In the period of 7 months (from 01.09.2017 to 31.03.2018) of the A-team implementation compared to the same period (from 01.09.2016 to 31.03.2017) without A-team, the consumption of defined daily doses of AR to 100 bed-days was reduced and thus financial spending. The aforementioned correlates with reduced number of patients treated with AR for 57%, ie from 938 to 402 (Fisher exact test, OR = 2,40, 95%CI = <2,13; 2,72>, p < 2.2*10^-16 => p < 0,001) without significant impact on mortality (the general mortality rate before A-team was 43.66 and after 40.30).
Multidisciplinary approach of A-team enabled optimization of clinical outcomes while minimizing unwanted consequences of using AR.
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