Background:
A point prevalence survey (PPS) conducted at Singapore General Hospital (SGH) in 2021 demonstrated that 60.6% of surgical inpatients were prescribed with antibiotics, of which 46.1% received extended-course (>24 hours) surgical antibiotic prophylaxis (SAP). Hence, SGH antimicrobial stewardship (AMS) program implemented a series of targeted AMS strategies among surgical departments, namely 1) data-driven feedback with pay-for-performance; 2) targeted education and capacity building; 3) engaging surgeons as partners in AMS; 4) digital stewardship tools; and 5) national collaborations. In this study, we aim to evaluate the impact of these multi-pronged AMS strategies on the change in antibiotic prescribing patterns in surgical inpatients using serial PPS findings.
Methods:
The PPS were conducted annually by AMS pharmacists at SGH between 2021 to 2024, with methodology in accordance with Global-PPS protocol. Data collected included proportion of surgical inpatients prescribed with antibiotic, SAP duration, compliance to antibiotic guidelines, and documentation of antibiotic indication and stop/review date.
Results:
In the study period, the proportion of surgical inpatients prescribed with antibiotics decreased from 60.6% to 54.5%. Proportion of patients with extended-course SAP improved from 46.1% (2021) to 37.6% (2023), before increasing to 44.0% (2024) based on PPS-defined SAP duration. Documentation of indication improved from 69.8% to 80.9% and antibiotic stop/review date increased from 42.6% to 52.7%. Compliance with antibiotic guidelines for antibiotic choice remained high (>80%) throughout.
Conclusion:
PPS is a useful tool to identify gaps in antibiotic prescribing and evaluate the effectiveness of AMS strategies. We demonstrated that targeted multi-pronged AMS strategies, tailored to different prescribing cultures among surgeons, reduce the proportion of patients prescribed with antibiotics and extended-course SAP. Continued efforts are necessary to sustain improvements and address persistent barriers.