Effectiveness of Antimicrobial Stewardship Program in Long-Term Care: A Five-Year Prospective Single-Center Study.

Objective: To report the effectiveness of the antimicrobial stewardship program (ASP) in a long-term care (LTC) facility, by analyzing the change in antimicrobial consumption and cost and multidrug resistance (MDR) rates over a 5-year period. Method: A prospective interventional study was conducted at a 106-bed facility (nursing home: 100 beds and an intensive care unit (ICU): 6 beds). The ASP was designed and led by a multidisciplinary team including an infectious disease consultant, two clinical pharmacists, a clinical microbiologist, and an infection control preventionist. Five key performance indicators were monitored: (1) intravenous (IV)-to-oral switch rate, (2) consumption of restricted IV antimicrobials (raw consumption and defined daily doses (DDD) index), (3) cost of restricted IV antimicrobials, (4) antimicrobial sensitivity profiles, and (5) MDR rate among hospital-acquired infections (MDR-HAI). Result: A ∼5.5-fold enhancement of the IV-to-oral switch and a 40% reduction in the overall consumption of restricted IV antimicrobials were observed. Regarding the cost, the cumulative cost saving was estimated as 5.64 million SAR (US$1.50 million). Microbiologically, no significant change in antimicrobial sensitivity profiles was observed; however, a large-size reduction in the MDR-HAI rate was observed, notably in ICU where it declined from 3.22 per 1,000 patient days, in 2015, to 1.14 per 1,000 patient days in 2020. Interestingly, the yearly overall MDR rate was strongly correlated with the level of antimicrobial consumption. Conclusion: The implementation of a multidisciplinary ASP in LTC facilities should be further encouraged, with emphasis on physicians' education and active involvement to enhance the success of the strategy.

In-vitro activity of ceftolozane/tazobactam against recent clinical bacterial isolates from two Saudi Arabian hospitals.

BACKGROUND: Antimicrobial resistance is continuously increasing. Adding tazobactam to ceftolozane improves the latter's activity spectrum against resistant strains. We aimed to determine the susceptibility of recently collected bacterial isolates to ceftolozane/tazobactam (C/T) and other antibiotics. METHODS: This was a prospective cohort study conducted between March 2017 and March 2018. The in-vitro activities of C/T and 14 other antibiotics were assessed against 192 gram-negative bacterial (GNB) isolates (P. aeruginosa, K. pneumonia, E. coli, and other Enterobacterales) prospectively collected from two hospitals in Saudi arabia; in the laboratories of the International Health Management Associates Inc. Samples were obtained from intensive care units (ICUs) and non-ICU locations. The minimum inhibitory concentrations (MICs) of the antibiotics were determined by broth microdilution. Isolates were obtained from different infection sites [urine (31.8%), urinary bladder samples (15.1%), abscess/pus (20.3%), endotracheal aspirates (18.8%)]. RESULTS: Our sample showed substantial drug resistance; 66.1% of the collected isolates showed either multiple or extensive drug resistance. Susceptibility rates of P. aeruginosa (n = 50), E.coli (n = 40), K. pneumoniae (n = 64) and other Enterobacterales (n = 38) to C/T were 74%, 87.5%, 48.4% and 71.1%, respectively. According to MIC50 values (1 µg/mL for both P. aeruginosa and other Enterobacterales, 0.5 µg/mL for E.coli, and 4 µg/mL for K. pneumoniae), C/T was among the most potent antibiotics against these isolates. CONCLUSIONS: C/T displayed high potency against all examined bacterial isolates. It was mainly active against E.coli followed by P.aeruginosa and other Enterobacterales and its lowest susceptibility rate was reported against K. pneumoniae.

Successful management of COVID-19 outbreak in a long-term care facility in Jeddah, Saudi Arabia: Epidemiology, challenges for prevention and adaptive management strategies.

The global transmission of SARS-COV-2 constitutes a highly challenging situation for long-term care facilities, especially with the lack of standardized and approved procedures. Residents in these facilities are at high risk for contamination due to proximity, and to morbidity and mortality given their advanced age and critical baseline health conditions. This paper exposes the experience and outcomes of a COVID-19 outbreak in a long-term facility in Jeddah, Saudi Arabia, which occurred after admission of a new resident despite high baseline level of alertness including systematic isolation and screening of all newly admitted residents. We highlight the challenges for case detection and application of protective measures, and describe the adaptive management strategies implemented to contain the outbreak.