SGH study shows benefits of early inpatient antibiotics prescription review
Singapore, 26 November 2019 – If patients are suspected of bacterial infection, doctors in most hospitals may first prescribe antibiotics based on his clinical experience and judgement while waiting for bacterial culture test results 72 hours later to confirm the diagnosis and identify the infection-causing bacteria. However, if patients do not have bacterial infection, antibiotics may cause more harm than good as studies have shown that high usage of antibiotics is associated with increased levels of antibiotics resistance.
To reduce unnecessary consumption, Singapore General Hospital (SGH) is the only hospital in Singapore to bring forward its antibiotics review from 72 hours to within 24 hours of it being prescribed. SGH's Antimicrobial Stewardship Programme (ASP) team will examine patients' records, paying close attention to possible drug-drug interaction, and all other clinical conditions (including an infection) that might be causing signs of fever.
"Overuse and misuse of antibiotics allow the development of antibiotic-resistant bacteria. When that happens, the once easily treatable illnesses such as urinary tract infection become difficult to treat, leading to longer hospital stay, larger medical bill, and higher death risk. One way to avoid the problem is not giving antibiotics to patients who clearly do not need it," said Associate Professor Andrea Kwa, Assistant Director (Research), Department of Pharmacy, SGH. Prof Kwa is also the study's senior and corresponding author.
In 2016, the ASP team comprising an infectious diseases specialist and infectious diseases clinical pharmacists, analysed retrospective data of 12,000 cases between January 2010 and December 2014 to evaluate the clinical outcomes and safety of its early antibiotics review practice.
They found that the team had recommended doctors to stop antibiotics treatment for close to 800 patients during the period. More than 70 per cent, of which, were accepted. The other doctors who declined cited reasons that patients were getting better, or had preferred to wait for bacterial culture test results before making a decision.
Patients in the study were 70 years old on average, and had fever caused by cancer, without identifiable cause, or viral infection. Antibiotics prescribed include piperacillin-tazobactam, meropenem, ciprofloxacin, ertapenem, imipenem, and cefepime.
The ASP team also discovered that patients in the recommendation-acceptance group had significantly shorter length of stay (by about a week) and fewer antibiotics treatment days (by nearly 3 days), which meant a cost saving of close to $11,000 per patient as compared to patients in the other group. More importantly, the study has shown that it is safe to stop patients' antibiotics treatment if there is no strong evidence to suggest a bacterial infection even before the bacterial culture test results are available.
"Teamwork in healthcare is very important as it can positively affect patient safety and outcome. By leveraging on the training and experience of healthcare professionals from different teams and departments, we can collectively make decision that is best for patients. Our early antibiotics review practice is an example and clearly a step in the right direction. We owe it to ourselves and our patients to keep them safe," said Dr Jasmine Chung, ASP Director, and Consultant, Department of Infectious Diseases, SGH.
The study findings were published in the peer-reviewed International Journal of Antimicrobial Agents in May this year.
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