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Discontinuation of Antibiotic Therapy within 24 hours of Treatment Initiation in Patients with No Clinical Evidence of Bacterial Infection: A 5-year Safety and Outcome Study from Singapore General Hospital (SGH) Antimicrobial Stewardship Program (ASP).

BACKGROUND: Overprescribing of antibiotics in patients with no bacterial infection is of growing global concern. It's important for timely Antimicrobial Stewardship Program (ASP) intervention to discontinue antibiotics in patients whose symptoms can be explained by non-infective causes, without availability of bacterial cultures and susceptibilities reports. Our study aims to evaluate clinical outcomes and safety of early ASP review in these patients.

METHODS: Retrospective review of ASP database (January 2010 to December 2014) was conducted, to identify patients whom ASP recommended discontinuation of empiric antibiotics within 24hours of prescribing. Demographics were collected. Clinical outcomes - duration of therapy, length of hospital stay (LOS), infection-related readmissions and all-cause mortality, were compared between interventions accepted and rejected groups. Continuous data was analyzed via unpaired Student's t-test. Categorical data were analyzed using Χ2 test or Fisher's exact test, as appropriate.

RESULTS: ASP team recommended 794 interventions [overall acceptance rate of 72.9% (579/794)]. There was no significant difference in underlying demographics, and Charlson Co-morbidity scores between the 2 groups. However, interventions-acceptance group had significantly shorter duration of therapy by 2.61 days (2.72±3.04 days vs 5.33±2.54 days; p<0.01) and LOS by 7.41 days (7.98±13.14 vs 15.39±22.62; p<0.01), with estimated cost savings of S$10817 per patient. There were no significant differences in 14-day mortality and readmission rates between the 2 groups.

CONCLUSION: Prompt ASP interventions in SGH were associated with significant reduction in duration of therapy and LOS, with cost-savings. We have demonstrated that it is safe to discontinue antibiotics within 24hours of prescribing in patients with no evidence of bacterial infections.

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