Stewardship Programmes a Potential Gamechanger for Hospital Antibiotic Use

Data gathered from a recent cross-sectional survey on antibiotic use among in-patients at the University Hospital of the West Indies (UHWI) and the Cornwall Regional Hospital (CRH) are being used to develop and roll out stewardship programmes at the institutions.

Internal Medicine Physician at the UHWI and the CRH, Dr. David McGowan, who led the study, recently copped the award for ‘Most Impactful Oral Presentation’ at the 14th Annual National Health Research Conference.

Dr. McGowan informed a JIS Think Tank on February 27, that stewardship involves several parts, including the promotion, monitoring, assessment and encouraging or improving antibiotic use.

He added that this study attempted to fill a gap in knowledge on antimicrobial stewardship in the local context, as there is presently very little data on the subject in that regard.

“At both institutions, what we did was select all the patients admitted on the survey days and we went through the medical records to see if they were on antibiotics or not. We were also looking for some specific indicators of stewardship and anything that we could tweak to improve that,” Dr. McGowan said.

“We’re also looking at a rough analysis of cost. The cost analysis we presented was direct drug costs, not any of the associated costs related to the medications, so just the antibiotics and the prices provided by the pharmacy departments in both institutions,” he explained.

Dr. McGowan further informed that the survey’s objective is to estimate the prevalence of antibiotic use, evaluate antibiotic usage patterns and antimicrobial stewardship at the CRH and UHWI.

This data, he noted, will position these institutions to be better able to address potential issues of antimicrobial resistance and the diminishing lifespan of the drugs used by patients.

“Antimicrobial or antibiotic resistance is a global threat. The World Health Organization recognises it as one of the top-10 public health threats facing the world, and the issue really is that as you use antibiotics, the bugs you’re using them to treat develop resistance and they’re no longer effective and that poses a challenge, and that you need new antimicrobials, new antibiotics,” Dr. McGowan said.

“One of the things that we can do to improve the lifespan of antibiotics and the efficacy is antimicrobial stewardship, which basically means responsible use of the antimicrobials,” he added.

The study involved 368 patients admitted to the UHWI and CHR on specific days from August 2021 to January 2022. Prevalent antibiotic use was defined as being administered at least one antimicrobial during the survey day.

The study revealed that a little more than half of the population in both institutions were on antibiotics.

Dr. McGowan noted that stewardship programmes can also help minimise the negative economic effects of antibiotic misuse.

“In terms of cost, what we did was to look at each institution by the number of patients on the antibiotic and the unit cost of the antibiotic and when we did that, we came up with a total cost for each institution for the survey day and then we multiplied that by 365 to give us an estimated cost for the year,” he said.

“The cost for the year just at those two institutions worked out to about US$1.7 million. It’s not an insignificant cost, and so how we use antibiotics has potential economic impact as well,” he outlined.

A stewardship programme is being rolled out at the UHWI, while a similar programme is being developed for CRH, based on the institution’s specific needs.