Khairil Erwan Khalid

Abstract

Introduction: The Antimicrobial Stewardship (AMS) program had been advocated to promote the rational use of antibiotic prescribing. However, the outcome of AMS in promoting the judicious use of carbapenem, and thus, minimising resistance, has not been widely studied in Malaysia. Objective: To investigate the types of interventions made by the AMS team, their acceptance, and the impact of such interventions on carbapenem consumption as well as the resistance pattern of carbapenem-resistant Enterobacterales (CRE). Method: This was a retrospective study conducted in adult medical wards of the Kuala Lumpur General Hospital (HKL), whereby data was extracted from the AMS forms of patients and subsequently reviewed by the AMS team from January to December 2016. Result and Discussion: The mean (SD) age of 169 patients included in this study was 59.2 (10.6) years. Ertapenem was the most prescribed carbapenem (44.4%), followed by meropenem (34.3%) and imipenem/cilastatin (21.3%). The study demonstrated that only 32% of carbapenem therapy had been empirically initiated, while, 68 cases (40.2%) were classified as unjustified use. Out of these cases, 39 cases (57%) were recommended to be discontinued, 25 cases (37%) were to be de-escalated and 4 cases (6%) were set for changing/escalation. The acceptance rate was reported to be around 73.5% (50 out of 68 cases). After one year of AMS implementation, carbapenem consumption (as shown by the defined daily dose/1000 inpatient bed-days) reduced by 33.7%. Similarly, a notable decrease in CRE cases (33.3%) was observed following a year of AMS initiation. Conclusion: AMS-guided interventions were able to demonstrate a reduction in carbapenem consumption as well as CRE rates in the medical wards.