Prospective Observational Study of De-Escalation of Empirical Antibiotics in Fiji’s National Hospital

Abstract: Background: Antimicrobial resistance is a global health threat and Fiji is not
exempt. The appropriate prescribing and timely de-escalation of antibiotics as an integral
component of antimicrobial stewardship has been recently introduced in Fiji to help curb
antimicrobial resistance through de-escalation, leading to a reduced opportunity for the
induction of resistance. Objectives: To assess whether empirical antibiotics are being
adjusted in a timely fashion in patients admitted with a diagnosis of suspected infection in
the Colonial War Memorial Hospital( CMWH) over three months. Method: The study was
undertaken on patients admitted to the acute medical ward and intensive care unit of the
CWMH in Suva (Fiji’s largest hospital). A total of 474 patients were prospectively enrolled
at admission when prescribed empiric antibiotic therapy for suspected infections between
February and April 2019. Results: A total of 356 patients admitted to the Acute Medical
Ward and 118 admitted to the Intensive Care Unit were prescribed empiricalantibiotics.
These 474 patients were prospectively observed to determine the factors influencing the extent and the timing of antibiotic de-escalation. Only 137 (29%) patients had their antibiotic regimen de-escalated in the first 72 h post-admission based on their microbiological results, whereas, 207 (42%) were de-escalated more than 72 h after admission (OR = 0.5, 95% CI 0.3–0.89; p < 0.016). Conclusions: At CWMH, antibiotic de-escalation is slow and may be improved by quicker laboratory reporting, greater access to laboratory results for prescribers, and the availability of a wider range of narrow-spectrum antibiotics to assist de-escalation.