Teaching antimicrobial stewardship based on lessons learned from a study of the prescribing pattern of piperacillin/tazobactam in a tertiary care hospital.

Ragini Vaishnav, Radhiya Buridi. Sultan Qaboos University, Muscat, Oman

Teaching antimicrobial stewardship to senior clerkship students at Sultan Qaboos University, College of Medicine took a revolutionary turn recently with a very favorable student satisfaction outcome. In accordance with the correlation between early antibiotic intervention and improved patient outcome in seriously ill patients, Sultan Qaboos University Hospital (SQUH) recently commenced prescribing piperacillin/ tazobactam in the Accident and Emergency (A&E) Department.

In order to audit the appropriate use of piperacillin/ tazobactam so that resistance and adverse patient outcomes are minimized, a retrospective study was designed to describe the prescribing pattern of piperacillin/ tazobactam in the Accident and Emergency department at Sultan Qaboos University Hospital (SQUH). A study objective was to compare the prescribing pattern in the (A&E) with guidelines set up by SQUH. A total of 162 patients with a total of 176 episodes were studied. Medical health records were reviewed to obtain patient data.Demographic data, dose duration, culture, and indication for piperacillin/tazobactam treatment were collected. SPSS program, version 19, was used for data analysis. Chi-square (χ²) test was used to evaluate the association between different parameters.

The rate of appropriateness of prescribing according to SQUH guidelines was 33/176 (18.8%). The main indication of appropriate piperacillin /tazobactam was febrile neutropenia (13.1%). The rate of inappropriateness of piperacillin/tazobactam prescription was 143/176 (81.2%).The most inappropriate indication being urinary tract infections (19.9%).The finding of this study were used to design a one day workshop on antimicrobial stewardship in a small group setting. The workshop was interactive and had objectives that were addressed by a big pharma talk, the pros and cons of which were discussed by the students. Other interactive sessions addressing and emphasizing the appropriate use of antimicrobials included presentations and viewing a film on resistance. The outcome was favourable as judged by feedback questionnaires filled in by students.