Who listens and who doesn't? Factors associated with adherence to antibiotic stewardship intervention in a Singaporean tertiary hospital. (September 2020)

• Record Type: Journal Article
• Authors: Wee, Liang En; Chung, Shimin Jasmine; Tang, Si Lin Sarah; Liew, Yi Xin; Tan, Lun Yi; Cherng, Pei Zhi Benjamin; Kwa, Lay Hoon Andrea; Chlebicki, Maciej Piotr
• Is Part Of: Journal of global antimicrobial resistance. Volume 22(2020)
• Page Start: 391
• Page End: 397
• Publication Date: 2020-09
• Subjects: Antibiotic stewardship -- Adherence -- Compliance -- Interventions; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2020.04.006
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: Adherence to antibiotic stewardship (ASP) intervention is non-mandatory. Identifying contributory factors to adherence may enhance compliance. ASP interventions in surgical units and culture-guided interventions had lower odds of adherence. ASP interventions for de-escalation and carbapenem-related interventions had lower odds of adherence. Verbal communication of ASP intervention was associated with higher odds of adherence. Abstract: Introduction: Antibiotic stewardship programmes (ASPs) can improve patient outcomes by prospective audit and feedback with interventions. However, adherence to ASP interventions is not mandatory. Identifying factors associated with improved adherence may help to enhance ASP recommendations and activities. Methods: A retrospective cohort study was conducted, comprising all ASP interventions performed as part of the prospective audit and feedback strategy in our institution (an acute tertiary-care hospital in Singapore) from January 2016 to July 2018. Adherence to ASP intervention was ascertained based on documented compliance with the recommended interventions within 48 h. Factors associated with adherence to ASP interventions, such as patient demographics, clinical condition, type of infection, and characteristics of ASP interventions were identified using the χ 2 test for categorical variables. On multivariate analysis, factors independently associated with adherence to ASP intervention were identified using logistic regression. Results: Adherence to ASP intervention was 81.9% (5758/7028). On univariate and multivariate analysis, interventions coupled with direct communication via phone call (adjusted odds ratio [aOR] 1.61, 95% CI 1.23–2.08) were associated with higher odds of adherence, whereas admission to a surgical unit, intervention involving carbapenem use, and recommendation to de-escalate or discontinue antibiotics were associated with lower odds of adherence to ASP interventions. Conclusion: Although adherence rates to ASP interventions were relatively high, interventions made to the surgical unit and recommendations related to carbapenem use were not so well received. Interventions communicated verbally via phone call were well received, highlighting the need for a close working relationship between ASP teams and hospital physicians.