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Title: Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore
Authors: Yeo, C.-L.
Chan, D.S.-G.
Earnest, A. 
Wu, T.-S.
Yeoh, S.-F.
Lim, R.
Jureen, R.
Fisher, D.
Hsu, L.-Y.
Issue Date: Apr-2012
Citation: Yeo, C.-L., Chan, D.S.-G., Earnest, A., Wu, T.-S., Yeoh, S.-F., Lim, R., Jureen, R., Fisher, D., Hsu, L.-Y. (2012-04). Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore. European Journal of Clinical Microbiology and Infectious Diseases 31 (4) : 583-590. ScholarBank@NUS Repository.
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. © Springer-Verlag 2011.
Source Title: European Journal of Clinical Microbiology and Infectious Diseases
ISSN: 09349723
DOI: 10.1007/s10096-011-1351-6
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