Prospective Observational Study of De-Escalation of Empirical Antibiotics in Fiji’s National Hospital

TL;DR

This study examines how quickly antibiotics are adjusted in hospitalized patients in Fiji to reduce antimicrobial resistance.

Contribution

The study provides empirical evidence on antibiotic de-escalation practices in a resource-limited setting.

Findings

Only 29% of patients had antibiotics de-escalated within 72 hours of admission.

De-escalation after 72 hours was associated with slower laboratory reporting and limited access to narrow-spectrum antibiotics.

Abstract

Background: Antimicrobial resistance is a global health threat and Fiji is not exempt. The appropriate prescribing and timely de-escalation of antibiotics as an integral component of antimicrobial stewardship has been recently introduced in Fiji to help curb antimicrobial resistance through de-escalation, leading to a reduced opportunity for the induction of resistance. Objectives: To assess whether empirical antibiotics are being adjusted in a timely fashion in patients admitted with a diagnosis of suspected infection in the Colonial War Memorial Hospital( CMWH) over three months. Method: The study was undertaken on patients admitted to the acute medical ward and intensive care unit of the CWMH in Suva (Fiji’s largest hospital). A total of 474 patients were prospectively enrolled at admission when prescribed empiric antibiotic therapy for suspected infections between February and April 2019. Results: A total of 356 patients admitted to the Acute Medical Ward and 118 admitted to the Intensive Care Unit were prescribed empiricalantibiotics. These 474 patients were prospectively observed to determine the factors influencing the extent and the timing of antibiotic de-escalation. Only 137 (29%) patients had their antibiotic regimen de-escalated in the first 72 h post-admission based on their microbiological results, whereas, 207 (42%) were de-escalated more than 72 h after admission (OR = 0.5, 95% CI 0.3–0.89; p < 0.016). Conclusions: At CWMH, antibiotic de-escalation is slow and may be improved by quicker laboratory reporting, greater access to laboratory results for prescribers, and the availability of a wider range of narrow-spectrum antibiotics to assist de-escalation.

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