Leading an Antibiotic Stewardship Initiative Through a Quality Improvement Collaborative Among 22 Hospitals in a Lower Middle Income Country

BACKGROUND The emergence of colistin resistant Carbapenem Resistant Enterobacteriaceae (CRE's) within a period of 4 months caused a team of professionals to raise the alarm. In a country lacking standardized microbiological testing, no restriction on antibiotics usage and having basic infection prevention programs, there was a need to address antimicrobial stewardship (AMS) nationally. The success of one tertiary hospital in building an AMS program resulted in a national initiative for 22 hospitals. METHODS The AMS program design included a driver diagram for the hospitals covering a catchment area of approximately 80% of the total population. A multidisciplinary team of 5 members from each hospital was responsible for implementing the activities which included; standardization of microbiological testing through hands-on workshops utilizing the American Society for Microbiology and the Clinical and Laboratory Standard Institute (CLSI) guidelines. Developing evidence based national guidelines for infections and empiric treatment and building the capacity of clinical pharmacists, medical doctors, infection control coordinators through shadowing of the AMS core team at the tertiary hospital. A data collection sheet was developed using Microsoft Access to collect data about antibiotics Days of Therapy (DoT) in line with CDC guidelines to evaluate improvements. RESULTS The effect of the AMS program was noted by a statistically significant drop in the restricted antibiotics DoT ranging between 23-74% in the vancomycin, colistin and carbapenems usage (p CONCLUSIONS The achievements of AMS interventions with minimal resources can be used as a model for regional countries in the fight against the spread of resistant bacteria.