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Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore

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Abstract

We evaluated the impact of a prospective audit and feedback antimicrobial stewardship program (ASP) on antibiotic prescription and resistance trends in a hematology-oncology unit in a university hospital (National University Cancer Institute, Singapore [NCIS]). A prospective interrupted time-series study comprising 11-month pre-intervention (PIP) and intervention evaluation phases (IEP) flanking a one-month implementation phase was carried out. Outcome measures included defined daily dose per 100 (DDD/100) inpatient-days of ASP-audited and all antibiotics (encompassing audited and non-audited antibiotics), and the incidence-density of antibiotic-resistant microorganisms at the NCIS. Internal and external controls were DDD/100 inpatient-days of paracetamol at the NCIS and DDD/100 inpatient-days of antibiotics prescribed in the rest of the hospital. There were 580 ASP recommendations from 1,276 audits, with a mean monthly compliance of 86.9%. Significant reversal of prescription trends towards reduced prescription of audited (coefficient = −2.621; 95% confidence interval [CI]: −4.923, −0.319; p = 0.026) and all evaluated antibiotics (coefficient = −4.069; 95% CI: −8.075, −0.063; p = 0.046) was observed. No changes were seen for both internal and external controls, except for the reversal of prescription trends for cephalosporins hospital-wide. Antimicrobial resistance did not change over the time period of the study. Adverse outcomes—the majority unavoidable—occurred following 5.5% of accepted ASP recommendations. Safe and effective ASPs can be implemented in the complex setting of hematology-oncology inpatients.

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Acknowledgments

We would like to acknowledge Dr. Jennifer Ho, Dr. Eng-Kiang Lee, and Dr. Indumathi Venkatachalam for their assistance in running the antimicrobial stewardship program (ASP) and Mr. Wee Chuan Hing for his assistance with the data retrieval. We would also like to thank the clinical staff of the National University Cancer Institute, Singapore (NCIS) for their support of the program.

Conflicts of interest

This study was carried out as part of our routine work, and was unfunded.

L.-Y.H. has received research funding and speaker’s honoraria from Pfizer, AstraZeneca, Janssen & Cilag, and Merck, Sharpe & Dohme. All other authors declare no competing interests with regards to the published material in this manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore

    C.-L. Yeo, T.-S. Wu & S.-F. Yeoh

  2. Department of Laboratory Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore

    D. S.-G. Chan & R. Jureen

  3. Clinical Research Unit, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    A. Earnest

  4. Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 2 Jalan Bukit Merah, Singapore, 169547, Singapore

    A. Earnest

  5. Department of Hematology-Oncology, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore

    R. Lim

  6. Department of Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore

    D. Fisher & L.-Y. Hsu

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  1. C.-L. Yeo
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  2. D. S.-G. Chan
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  4. T.-S. Wu
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  6. R. Lim
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  7. R. Jureen
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  8. D. Fisher
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  9. L.-Y. Hsu
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Correspondence to L.-Y. Hsu.

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Yeo, CL., Chan, D.SG., Earnest, A. et al. Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore. Eur J Clin Microbiol Infect Dis 31, 583–590 (2012). https://doi.org/10.1007/s10096-011-1351-6

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  • DOI: https://doi.org/10.1007/s10096-011-1351-6

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