Antimicrobial Approval Program and Impact on Antimicrobial Prescription, Antimicrobial Resistance, and Mortality in a Tertiary-Care Teaching Hospital in Thailand: a Preliminary Study

Background: Antimicrobial resistance is now a major issue confronting healthcare providers and patients. Increasing of antimicrobial resistance, high costs of new antimicrobial agents, toxicity of old antimicrobial agent i.e. colistin, limit the option for treating patients infected with multidrug-resistant bacteria, which resulted in bad outcomes. Antimicrobial stewardship is one of the promising interventions to reduce antimicrobial resistance. Objective: To determine the effect of antimicrobial approval program on antimicrobial prescription, antimicrobial resistance, and mortality rate in a tertiary-care teaching hospital in Thailand Methods: A 3-year planned, quasi-experimental study is conducted; a 1-year period before intervention (period 1: January 1, 2008 to December 31, 2008), a 1-year intervention period (period 2: January 1, 2009 to December 31, 2009), and a 1-year follow-up period (period 3: January 1, 2010 to December 31, 2010). The intervention in period 2 included educating healthcare personnel on antimicrobial prescription, antimicrobial approval for 6 antimicrobial agents including carbapenems (meropenem, imipenem), piperacillin/tazobactam, cefoperazone/sulbactam, colisitn, and vancomycin. All cases that need these 6 antimicrobial agents will be reviewed by specialists. The antimicrobial susceptibility patterns of isolates and mortality of patients infected or colonized with these 6 pathogens are monitored; Pseudomonas aeruginosa, Acinetobacter baumannii, ESBL-producing Klebsiella pneumoniae and Escherichia .coli, Methicillin-resistant staphylococcus aureus, and enterococci. Results: The monthly hospital antimicrobial dosage was reduced by 30% (p=0.005) for cefoperazone/sulbactam, 26.6% for imipenem (p=0.03), and 20.6% for vancomycin (p=0.011). The dosage was non-statistically significant reduced for piperacillin/tazobactam and meropenem. The percentage of ESBL producing E.coli increased 19% in period 2 compare to period 1 (p<0.001). The proportion of carbapenem-resistant A. baumannii, and P.aeruginosa, methicillin-resistant staphylococci, and vancomycin-resistant enterococci are not changed in these 2 periods. The mortality rates in period 2 are not different from period 1 for all sentinel pathogens. Conclusions: Preliminary study suggested that antimicrobial approval program resulted in reduction in unnecessary antimicrobial prescription, with unchanged in mortality rates. Multidrug-resistant pathogens are not affected by the program; however, longer period of study is needed to determine the ecology changes of these pathogens.