Antibiotic stewardship: sharing experience from a teaching hospital in united kingdom. drugs, bugs, bucks and brains

• Published in: Pathology 2012, Vol.44, p.S75-S76
• Main Authors: Doshi, N., Damant, G., Shatwell, J., Amelan, R., Taylor, M., Maxwell, S., Catania, J.
• Format: Article
• Language: English
• ISSN: 0031-3025; 1465-3931
• DOI: 10.1016/S0031-3025(16)32803-3

Sub-optimal usage of antimicrobials is associated with rise in antimicrobial resistance across the globe. Antimicrobial stewardship has been advocated by Department of Health (DH) UK to achieve prudent antibiotic prescribing. Our study aims to highlight the 858 bed UK NHS hospital’s antimicrobial prescribing practises, to promote appropriate choices and to educate the prescri-bers. This can add to hospital cost savings and control HCAI like Clostridium difficile or multi-resistant infections. A multidisciplinary team visited adult in-patients for different specialities and filled a proforma based on the ‘Antimicrobial care bundle’ within the Health and Social Care Act, UK 2010. Inappropriate antibiotic choices were changed and documented after discussing with the clinicians. Data were presented to raise awareness within prescribers and the board members. During March 2010–May 2011, the hospital antibiotic prescribing prevalence was around 22% of which 75% was appropriate and 25–50% needed intervention. Stopping or de-escalating antibiotics were the major changes. Overall documentation of antibiotic usage, clinical indication and culture sensitivity was good in the drug charts. Around 75% antibiotics were prescribed in line with local antibiotic guidelines and were reviewed by the clinical team within 72hours. Piperacillin, tazobactam and co-amoxi cla-vulanate acid were the commonly used intravenous antibiotics. This was reflected in quarterly antibiotic and other clinical audits. A rolling antimicrobial stewardship programme with several elements was introduced engaging clinician and hospital executive ownership. Real time education, daily review of antibiotics, and robust antibiotic policies with patient involvement are the mainstay of this challenging health care surveillance tool.