Pattern of high-cost antibiotics before and after an antibiotic stewardship program at Namazi hospital in Shiraz

Background and Objectives: The excessive use of anti-microbial medicines over the past few decades has led to an ever-increasing spread of microbial resistance, reducing the efficiency of anti-microbial drugs, and the costly and time-consuming treatment for infectious diseases. Hence, in many countries in the world, a variety of corrective programs in the health system have been planned and implemented to reduce and control the use of this drug group. The purpose of this study is to investigate the clinical and economic effects of an antibiotic stewardship program on prescribing 5 expensive antimicrobial drugs in Namazi Hospital, Shiraz, Iran. Materials and Methods: According to the antibiotic stewardship program, all wards of Namazi hospital should consult with the infectious diseases service within 3 days when ordering any of the five expensive and broad-spectrum anti-microbial drugs including Amphotericin B liposomal, Caspofungin, Colistimethate sodium, Linezolid, and Voriconazole. Infectious disease service was authorized to either approve or disapprove theses consults. The pre- and post- antibiotic stewardship program periods were defined as 2016-2017 and 2017-2018, respectively. Four indexes including 1) total consumption rate 2) per capita consumption 3) total cost, and 4) per capita rial were measured annually to assess the change in process of prescribing these antimicrobials. Clinical outcome indexes including mortality rate and length of hospital stay were also considered. These data were extracted from the Hospital Information System and also patients’ medical charts. Results : A decrease in total consumption rate (31.3%), per capita consumption rate (24.64%), direct cost (34.98%), and per capita Rial (32.21%) were detected. However, the decrease in total cost and per capita consumption, were statistically significant. In addition, the defined daily dose of studied antimicrobials decreased. Regarding clinical outcome indexes, the length of hospital stay, rate of mortality and duration of antimicrobial drug administration also decreased. Albeit, only the decrease in antimicrobial drugs duration was statistically significant. Among 600 consulting requests from the infectious diseases service, 32.5% were disapproved. The most adherence rates to the antibiotic stewardship program were in surgery and intensive care unit wards. In 14.2% of cases, patients received at least one of these antibiotics without consulting with the infectious disease service. In addition, 4% of antibiotic prescriptions were against the infection specialist recommendations. Conclusion :Our study data suggest that the active contribution of infection specialists in the antibiotic stewardship program can significantly decrease the total cost as well as per capita consumption of high cost medications of along with improving the clinical outcome.