Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR in an acute care hospital in Qatar.

Background: The excessive and inappropriate use of antibiotics is universal across all healthcare facilities. In Qatar there has been a substantial increase in antimicrobial consumption coupled with a significant rise in antimicrobial resistance (AMR). Antimicrobial stewardship programmes (ASPs) have become a standard intervention for effective optimization of antimicrobial prescribing.

Methods: A before-after study was conducted in Hamad General Hospital (603 bed acute care hospital): 1 year before implementation of a comprehensive ASP compared with the following 2 years. The ASP included a hospital-wide pre-authorization requirement by infectious diseases physicians for all broad-spectrum antibiotics. Prevalence of MDR was compared with antimicrobial consumption, calculated as DDD per 1000 patient-days (DDD/1000 PD). Susceptibility was determined using broth microdilution, as per CLSI guidelines. Antibiotic use was restricted through the ASP, as defined in the hospital's antibiotic policy.

Results: A total of 6501 clinical isolates of were collected prospectively over 3 years (2014-17). Susceptibility to certain antimicrobials improved after the ASP was implemented in August 2015. The prevalence of MDR showed a sustained decrease from 2014 (9%) to 2017 (5.46%) (0.019). There was a significant 23.9% reduction in studied antimicrobial consumption following ASP implementation (0.008). The yearly consumption of meropenem significantly decreased from 47.32 to 31.90 DDD/1000 PD (0.012), piperacillin/tazobactam from 45.35 to 32.67 DDD/1000 PD (0.001) and ciprofloxacin from 9.71 to 5.63 DDD/1000 PD (0.015) (from 2014 to 2017).

Conclusions: The successful implementation of the ASP led to a significant reduction in rates of MDR , pointing towards the efficacy of the ASP in reducing AMR.