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Title: Evaluation of antibiotic use in a Lebanese hospital
Author: Ibrahim, Mohamad
ISNI:       0000 0004 5915 3802
Awarding Body: Cranfield University
Current Institution: Cranfield University
Date of Award: 2016
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Antimicrobial resistance is a significant global health problem. Misuse of antibiotics is associated with antimicrobial resistance which presents clinicians with treatment challenges and increases the complexity of the decision making process related to the selection of appropriate antibiotic therapy. Antibiotic resistant organisms can often lead to nosocomial infections (NIs) and undoubtedly causes patient harm and increases healthcare costs. According to the National Institute of Allergy and Infectious Diseases (NIAID), at least 70% of the nosocomial infections are caused by antibiotic-resistant organisms. In addition to the problem of inappropriate prescribing, the decreased production of antimicrobial agents over the past 25 years has restricted the arsenal of available antimicrobial agents. The combination of inappropriate antibiotic prescribing practices and reduced research and development of new antimicrobial agents have promoted concerns that society may soon return to a pre-antibiotic era. Addressing the attitudes and behaviours that contribute to inappropriate antibiotic prescribing is a potentially effective and immediate solution to the growing antimicrobial resistance problem. Modifying clinicians' prescribing behaviour with antibiotic decision guidelines and highlighting the problematic side of this issue can promote judicious antibiotic prescribing practices. Representing the existing data regarding the use and misuse of antimicrobials in a Lebanese hospital can support and encourage initiating and complying with antibiotic stewardship programs and prescription guidelines. Purpose: The objectives of this study were to determine current levels and trends in prescribing antibiotics to patients in a Lebanese hospital, (2) to identify the factors that physicians considered when deciding to start antibiotics, (3) to explore whether antimicrobial use (empiric, prophylactic, targeted) will change when physicians fill out a form to document why they prescribed antibiotics, (4) to explore whether an increase in bacterial resistance occurs when antimicrobial consumption increases, (5) to explore the clinicians' perception towards antimicrobial use and antimicrobial stewardship program pre- and post- implementation of an antibiotic assessment form, (6) to explore the effect of the implemented antimicrobial stewardship intervention combined with hand hygiene (HH) on healthcare associated infection rate (HAIs) in the hospital. One-year retrospective study in a Lebanese hospital was conducted to determine the percentage of patients who received antimicrobial treatment and to identify the inappropriateness of their use in different hospital departments. A 12-months intervention was then implemented during which all attending physicians were asked to fill an antimicrobial assessment form (AAF) to document their rationale for starting antimicrobial therapy. In addition, this AAF was used to identify factors physicians considered when deciding to prescribe antimicrobials. Data from the AAFs suggested that physicians in the hospital often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start antimicrobial therapy. Data showed that antibiotic consumption and the median duration of empiric and targeted therapies decreased significantly during the intervention period when compared to the pre-intervention period. Antibiotic appropriateness was also increased significantly after the intervention was conducted. In addition, a better understanding of antimicrobial stewardship strategies was also noted by physicians after the implementation of the intervention. On the basis of these results, AAF filling was a successful intervention to reduce antibiotic use and to urge physicians to refer to antibiotic guidelines when initiating an antimicrobial agent. However, additional measures such as automatic stop orders and computer decision support may be easier and useful for reducing the duration of therapy in hospitals.
Supervisor: Lambert, R. J. W. ; Brown, Terry P. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Antibiotics ; inpatients ; hospitalized ; appropriateness ; inappropriateness ; stewardship ; teaching hospital ; antimicrobial resistance ; nosocomial infections