The impact of a multidisciplinary team on adherence to recommended antimicrobial therapy in neurosurgical units in Thailand
Kittiya Jantarathaneewat, Pataravit Rukskul, Pornchai Yodwisithsak, Wadrawee Kaewwichai, Bernard Camins, Anucha ApisarnthanarakAbstract
Purpose
To evaluate the impact of a multidisciplinary antimicrobial stewardship program (mASP) on adherence to recommended antimicrobial therapy in neurosurgical units.
Methods
A quasi-experimental study was conducted in Thammasat University Hospital between May 2020 and June 2022. Our primary outcome was adherence to recommended antimicrobial therapy, and secondary outcomes included clinical improvement, 30-day infectious disease–related mortality, antimicrobial use, and incidence of infection with multidrug-resistant (MDR) pathogens.
Results
Overall, 688 antimicrobial orders were reviewed during the study. The most prescribed antimicrobial for empiric therapy was piperacillin/tazobactam (266/688, 39.9%), and the most common source of infection was the respiratory tract (321/688, 46.7%). The overall adherence rate to recommended antimicrobial therapy was higher in the mASP period (70.3% vs 62.5%; P = 0.029). The overall acceptance rate of mASP recommendations was 83.1%. Furthermore, the mean volumes of carbapenem (P = 0.005) and vancomycin (P = 0.045) use declined, while the trend of cefazolin use increased (coefficient, 26.88; 95% confidence interval, 13.53 to 40.24; P < 0.001) during the study period. The incidence of infections caused by MDR pathogens significantly declined (P = 0.012), especially for infections caused by carbapenem-resistant Acinetobacter baumannii (P = 0.043). There were no differences in the secondary outcomes, inclusive of the proportion of patients with clinical improvement and 30-day infectious disease–related mortality.
Conclusion
Implementation of an mASP in neurosurgical units was associated with improved adherence to recommended antimicrobial therapy, reduced use of broad-spectrum antibiotics, and a decline in the incidence of infections with MDR pathogens.