Effectiveness of prospective audit-and-feedback intervention in promoting appropriate third-generation cephalosporin use at a tertiary public hospital in Malaysia
Abstract Background: Inappropriate use of broad-spectrum antibiotics accelerates the development of drug resistance in nosocomial pathogens. In Malaysia, the National Antimicrobial Guidelines (NAG), along with the feedback from antimicrobial stewardship (AMS) teams, serves as an important guide for antibiotic use in hospitals. Objectives: This study aimed to determine the effectiveness of a prospective audit-and-feedback intervention in promoting the appropriate prescribing of third-generation cephalosporins and timely culture and sensitivity (C&S) testing in patients admitted to a neurosurgical ward. Method: In the pre-intervention phase, a ward pharmacist examined medical records of the patients receiving treatment with third-generation cephalosporins. The use of a cephalosporin was deemed to be appropriate only if it was in line with either the NAG or the recommendations made by the AMS team. The laboratory reports were also checked to see if the C&S testing was performed right before the first dose of a cephalosporin was given. The findings were subsequently presented and discussed in a 2-hour feedback session. The post-intervention audit was performed in the same manner as in the pre-intervention phase. Results: Seventy cases were studied in the pre- and post-intervention phases each. The proportion of cases with appropriate use of third-generation cephalosporin increased significantly from 77.1% (54/70) to 95.8% (67/70) following the intervention (p=0.001). The proportion of cases with a C&S test performed timely also increased significantly from 38.6% (27/70) to 58.6% (41/70) (p=0.018). Conclusion: The prospective audit-and-feedback intervention was effective in improving the appropriateness of the prescribing of third-generation cephalosporins and timely culture and sensitivity testing, indicating the antimicrobial stewardship strategy had produced a positive outcome.