Antimicrobial Stewardship (AMS) program in private hospitals in the Philippines: Its acceptability, barriers, and enablers

Background@#Antimicrobials are drugs that are often misused and inappropriate antimicrobial prescribing often results in poor clinical outcome and drug resistance. Monitoring and regulation of antimicrobial use is currently being done by the Department of Health through the Antimicrobial Stewardship (AMS) Program. There is a need to determine the factors that affect successful implementation of an AMS program in private hospitals in the Philippines. This study was conducted to identify the enablers and potential barriers in implementing an AMS program in nine (9) private hospitals. @*Methodology@#A concurrent mixed methods design was used to assess various stakeholders’ (physicians, administrators, other AMS members) perceptions of existing or proposed AMS programs, and to identify barriers and enablers in their implementation. Quantitative data were collected using self-administered survey questionnaire to assess clinician’s acceptance of AMS programs. Qualitative data were collected through semi-structured one-on-one interviews of clinicians and other AMS personnel and focus group discussions (FGD) of selected clinician groups. Data were gathered from October 2018 to October 2019. @*Results@#409 clinicians were surveyed, 52 were interviewed and 46 sat for 13 sessions of FGDs. Overall, the survey established that physicians were well aware of antimicrobial resistance problem. Majority of the clinicians indicated general agreement with the currently practiced antimicrobial protocols in their hospitals and with the AMS program. However, there were disagreements in perceptions with how antimicrobial restrictions impair prescribing practices and overuse of the same. These responses were strong points of discussion during the Key Informant Interviews (KII) and FGDs. All respondents were amenable with the institutionalization of an AMS program in their hospitals. The hospital leadership’s commitment was determined to be the key enabler of a successful AMS program’s implementation. Barriers identified for hospitals with existing AMS programs were: lack of dedicated staff, resistance and/or non-cooperation of physicians, lack of support from non-medical departments, and inadequate cooperation between hospital personnel. Barriers identified, regardless of the status of the AMS programs were: deficiency in knowledge with developing and implementing an AMS program, inadequate information dissemination, unavailability of an IT-based monitoring for antibiotic use, and the influence of pharmaceutical companies on stakeholders with regards to antimicrobial use. @*Conclusion@#Similar enablers and barriers to a successful implementation of an AMS program were seen in the different hospitals. A hospital leadership’s commitment was determined to be the key enabler. The success or failure of any AMS program appears to depend on physician understanding, commitment and support for such a program. By involving the main players in an AMS program- the hospital administrators, clinicians and other key members, perceived barriers will be better identified and overcome, and enablers will help allow a successful implementation of an AMS program. This multi-center study was funded by Philippine Council on Health Research and Development ( PCHRD) and Pediatric Infectious Disease Society of the Philippines ( PIDSP) and was conducted by the PIDSP Research Committee.

Prevalence of healthcare-associated infections among the pediatric patients admitted at Philippine General Hospital from the years 2011-2014

@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Healthcare associated infections (HAIs) continue to be a major public health concern throughout the world particularly in developing countries wherein prevalence rates range from 5.7%-19.1%.</p> <p style="text-align: justify;"><strong>OBJECTIVES:</strong> The aims of this study were to determine the prevalence of HAIs among pediatric patients admitted at Philippine General Hospital and to describe the trends of annual prevalence of HAIs in relation to infection control programs implemented.</p> <p style="text-align: justify;"><strong>METHODOLOGY:</strong> A retrospective study was conducted at the 145-bed capacity wards and intensive care units of the Department of Pediatrics, Philippine General Hospital (PGH) from January 2011 to December 2014 wherein HAI records from the database of the Section of Infectious and Tropical Disease in Pediatrics (INTROP) were reviewed. The following data were collected and encoded: (1) number of patients admitted in the different areas: Pediatric wards (Ward 9 and Ward 11), PICU and NICU; (2) number of patients who developed HAIs; and (3) microbial isolates, sites and antibiotic susceptibility results. Trends of yearly prevalence of HAIs in relation to infection programs implemented were determined, and the microbial isolates and their antibiotic sensitivity patterns were described.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> Among 30,032 pediatric patients at risk for HAIs and admitted from January 2011 to December 2014, the prevalence of HAI was 11.37%. There was a decreasing trend in the yearly HAI rates from 2011 to 2014 which coincided with implementation of infection control programs and hiring of a part-time infection control nurse in 2012. The prevalence of HAIs was highest at the PICU (15.17%- 27.81%) followed by the two Pediatric wards, ward 9 (9.03%-19.87%) and ward 11(8.75%-14.76%) and lowest at the NICU (7.52%-9.44%). Top isolates were Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella pneumonia. Pseudomonas organisms were still sensitive to Ceftazidime, and Klebsiella to Meropenem.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> The overall HAI prevalence during the 4-year study period was 11.37% (9.14% - 13.65%) comparable to those seen in developing countries. There was a decreasing trend of prevalence annually that coincided with the implementation of various infection control programs and the hiring of a part-time infection control nurse. The microbial isolates obtained vary per area but overall the same organisms were isolated during the study periods which were susceptible to the empiric treatment given.</p>