PROSPECTIVE OBSERVATIONAL STUDY OF DE-ESCALATION OF EMPIRICAL ANTIBIOTICS AT CWMH, SUVA, FIJI.

Researchers: Young T1, Jenney AWJ2, Naidu R3, Tong D4
Researcher Affiliations: 1Department of Medical Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva;2 Department of Infectious Diseases, Monash University, Melbourne, Australia;3 Medical Unit, Colonial War Memorial Hospital, Ministry of Health and Medical Services, Fiji;4 World Health Organization, Country Office, Vientiane, Laos.
Keywords: De-escalation, antimicrobial stewardship, empirical antibiotics.
Prospective observational study of de-escalation of empirical antibiotics in patients admitted to CWMH
Introduction
Antimicrobial resistance was formally identified as a global health threat of high priority by the 68th World Health Assembly. Pacific nations, including Fiji, have also witnessed the emergence of multi-resistant organisms. Drug shortages and unavailability of certain antimicrobial agents makes treating such resistant infections a greater challenge in Fiji compared with better resourced nations. Therefore, antimicrobials are a precious resource to be used with care and a robust antimicrobial stewardship program greatly helps towards that end. Appropriate and timely de-escalation of antibiotic prescription for patients is an integral component to any antimicrobial stewardship program.
Method
A prospective observational study was performed by reviewing 474 consecutive patients admitted in the acute medical and intensive care wards for suspected infections and received empirical antibiotics for the period February to April 2019, at a tertiary hospital. Patient demographics, antibiotic regimen, duration of antimicrobial therapy, culture results and time to de-escalation of antibiotics were evaluated. Results The most common indication of empirical antibiotics in the admission notes was clinical sepsis with unknown focus. Of the 474 patients studied, only137 patients (29%) had their antimicrobial regimen de-escalated by 72 hours after admission based on their microbiological results. Indeed, patients were twice as likely to have their antimicrobial regimen revised based on culture results after being in hospital more than 72 hours than earlier (OR = 0.5, 95% CI 0.3 – 0.89; p < 0.016).
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Conclusion The empirical antimicrobial regimen of 29% of patients with suspected infection was de-escalated within 72 hours in our setting. This prospective observational study demonstrated a great need to reinforce the antimicrobial stewardship at CWMH, in particular the need for prompt delivery and follow up of microbiological results so that de-escalation, if warranted, could occur in a timely fashion. This would result in better antimicrobial use, while not compromising patient care and perhaps slow the emergence or even reduce the burden of antimicrobial resistance.