antimicrobial stewardship

Utilisation of Third-Generation Cephalosporins and the Occurrence of ESBL Microorganisms in a Malaysian General Hospital

    DOI: 10.52494/YMQX5390
    by Wei Chern Ang, Nor Ruzaini Ahmad, Chah Chah Ooi, Ainul Aqilah Abdul Muin and Mohammad Faisol Hamdi Omar.
    Vol. 7 No. 2 (2021): Malaysian Journal of Pharmacy / Published: December 31, 2021
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    Abstract

    Introduction: Bacteria had undergone an evolution since the introduction of antibiotics as a way of adaptation. The recent increase in cases of extended-spectrum beta-lactamases (ESBLs) and broad-spectrum antibiotics usage worldwide are of great concern. Objective: This study aims to establish the relationship between third-generation cephalosporin antibiotics usage and the occurrence of ESBL microorganisms in a state hospital in Malaysia. Method: A cross-sectional study utilising data from January 2014 to June 2017 for six-monthly uses of cefoperazone, cefotaxime, ceftazidime, ceftriaxone was expressed in defined daily dose (DDD) per 100 bed-days, while 6-monthly positive cultures of ESBL-producing Escherichia coli, Klebsiella pneumoniae were expressed as the frequency of infection and coloniser cases. Individual trends of antibiotics use-positive culture ESBL over time were analysed descriptively and by linear regression. Result: None of the third-generation cephalosporin use shows a significant trend over time. The most prescribed third-generation cephalosporin was ceftriaxone. The emergence of ESBL E. coli showed a significant reducing trend over time (r2 = 0.931, p < 0.001). No significant correlation was found between antibiotic use and the emergence of ESBL organisms. Conclusion: Our study found no significant correlation between third-generation cephalosporin use and the emergence of ESBL organisms in our setting. The association between third-generation cephalosporin use and ESBL emergence should not be considered universal, as the selection pressure of third-generation cephalosporin might be affected by other factors specific to the institution. The reducing trend of E. coli emergence may be due to the antimicrobial stewardship programme already in place. Additionally, ESBL-producing organisms may appear susceptible to third-generation cephalosporins in our laboratory yet be functionally resistant in vivo.

    Effectiveness of Pharmacist-Led Audit-and-Feedback Intervention in Promoting Appropriate Third-Generation Cephalosporin Use at a Tertiary Public Hospital in Malaysia

      DOI: 10.52494/MYWO5828
      by Rou Wei Tan, Chee Tao Chang, Kah Shuen Thong, Joo Thye Cheng, Huan Keat Chan and Meng Fei Cheah.
      Vol. 7 No. 2 (2021): Malaysian Journal of Pharmacy / Published: December 31, 2021
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      Abstract

      Objective: This study aimed to determine the effectiveness of a pharmacist-led audit-and-feedback intervention in promoting the appropriate prescribing of third-generation cephalosporins and timely culture and sensitivity (C&S) testing in patients admitted to a neurosurgical ward. Method: This quasi-experimental study was conducted from July 2019 to August 2020 in a tertiary public hospital in Malaysia. In the pre-intervention phase, seventy patients who have received treatment with third-generation cephalosporins were examined by a ward pharmacist. The use of a cephalosporin was deemed to be appropriate only if it was in line with either the National Antimicrobial Guidelines 2019 or the recommendations made by the Antimicrobial Stewardship team. The availability of C&S test performed before the first dose of cephalosporin was also studied. As an intervention, the findings were presented and discussed in a 2-hour feedback session. Subsequently, the post-intervention audit was performed in the same manner as in the pre-intervention phase. The primary outcome measures were the proportion of cases with appropriate use of cephalosporin and timely C&S testing. The variables were analysed descriptively. Pearson’s chi-square test was used to assess the differences in appropriateness of antibiotics use and C&S testing, in the pre- and post-intervention cohorts. Result: Seventy cases were studied in the pre- and another seventy in post-intervention phases. The proportion of cases with appropriate use of third-generation cephalosporin increased significantly from 77.1% (54 / 70) to 95.8% (67 / 70) following the intervention (p = 0.001). The proportion of cases with a C&S test performed timely also increased significantly from 38.6% (27 / 70) to 58.6% (41 / 70) (p = 0.018). Conclusion: The pharmacist-led audit-and-feedback intervention was effective in improving the appropriateness of the prescribing of third-generation cephalosporins and timely culture and sensitivity testing, indicating the antimicrobial stewardship strategy had produced a positive outcome.