LAUSR

BACKGROUND In most hospitals worldwide, 30% to 50% of antibiotics are prescribed either unnecessarily or inappropriately. In the largest tertiary hospital in Singapore, we observed that patients with neurological conditions were often initiated on antibiotics for change in mental state or isolated fevers. We hypothesize that Antimicrobial Stewardship Program (ASP) interventions to discontinue empiric antibiotics in neurological patients with no clinical evidence of bacterial infection is safe. We aim to compare clinical impact and safety outcomes of ASP interventions between accepted and rejected groups. METHODS Retrospective review of ASP database between January 2014 and December 2017 was conducted, among all patients admitted to the neurology department in Singapore General Hospital. Interventions were followed up and patients were classified into two groups -intervention acceptance and rejection groups. Demographic data, age-adjusted Charlson co-morbidity index, duration of antibiotics therapy, length of hospital stay post ASP intervention (PLOS), infection-related readmissions and mortality, were compared between the two groups. Data were expressed as mean ± standard deviation for continuous variables, and unpaired Student's t-test was performed to determine intergroup differences between mean values. RESULTS ASP team recommended 184 interventions [overall acceptance rate of 82.6% (152/184)]. There was no significant difference in demographics, and age-adjusted Charlson co-morbidity index between the 2 groups. Accepted group had shorter duration of therapy by 1.67 days (4.99±2.50 days vs 6.66±2.34 days; p<0.01) . Though not statistically significant, patients in the accepted group had a shorter PLOS by 2 days (22.5±22.2 days vs 24.5±51.4 days; p=0.83). There were no significant differences in 14-day mortality and readmission rates between the 2 groups. CONCLUSION In neurological patients with no clinical evidence of bacterial infections, ASP interventions to discontinue empiric antibiotics were not associated with increased mortality and readmissions, but were associated with significant reduction in duration of therapy.