Background: A point prevalence survey conducted at Singapore General Hospital in 2021 showed 48% of inpatients on antibiotics. We hypothesize that a mobile application, transforming complex antibiotic prescribing information into a succinct and individualized resource, will empower healthcare professionals and improve antibiotic prescriptions. Hence, we developed ABxSG using the behavioral design thinking approach (BDTA) to ensure positive user experience and sustained engagement. We aim to evaluate the impact of ABxSG on the proportion of inpatients on antibiotics, antibiotic appropriateness, and the number of antibiotic-related interventions by pharmacists. Methods: ABxSG was launched in March 2023. An interrupted time series analysis was conducted to evaluate its impact on the above outcomes measured using data collected from October 2021 to September 2024. There were 18 data points pre- and post-ABxSG. Results: Following the ABxSG launch, there was an immediate reduction in the proportion of inpatients on antibiotics by 1.66% (p < 0.01), followed by a sustained reduction of 3.12% at 18 months (p < 0.01). Piperacillin-tazobactam appropriateness increased by 2.76% at 1 month (p = 0.11) and further increased by 7.09% at 18 months (p < 0.05). Similarly, ceftriaxone appropriateness increased by 5.74% (p < 0.05) at 1 month and remained above pre-ABxSG levels. There was a significant increase in the number of pharmacist-led interventions for dosing optimization, with 96 more interventions/month at 18 months (p = 0.14). Conclusion: Antimicrobial stewardship teams must remain agile, embrace innovations, and adopt digital technologies to engage and empower clinicians. ABxSG reduced the proportion of inpatients on antibiotics and improved antibiotic prescriptions. The incorporation of BDTA in ABxSG, strong hospital leader support, and strategic planning to promote adoption led to its success.

At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. These antibiotics are not under the usual purview of the antimicrobial stewardship unit (ASU). Serum procalcitonin, a biomarker to distinguish viral from bacterial infections, can be used to guide antibiotic recommendations in suspected lower respiratory tract infection. We modified our stewardship approach, and used a procalcitonin-guided strategy to identify “high yield” interventions for audits in patients admitted with CA-ARI. With this approach, there was an increase in the proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6–8) vs. 6 (3–8) days, p < 0.001]. There was a significant decrease in patients with intravenous-to-oral switch of antibiotics to “complete the course” (45.3% vs. 34.4%, p < 0.05). Of the patients who had antibiotics discontinued, none were restarted on antibiotics within 48 h, and there was no-30-day readmission or 30-day mortality attributed to respiratory infection. This study illustrates the importance of the antimicrobial stewardship during the pandemic and the need for ASU to remain attuned to prescriber’s practices, and adapt accordingly to address antibiotic misuse to curb antimicrobial resistance.

Background/objectives: Studies evaluating the longitudinal impact (beyond a decade) of antibiotic stewardship programs (ASPs) on the volume/quality of antibiotic prescriptions, as well as the impact on antibiotic resistance, are lacking. Since 2008, the ASP at Singapore General Hospital has implemented various strategies in the following phases: (1) initiation, (2) expansion, (3) optimisation, and (4) innovation. In this study, we aim to evaluate the volume/quality of antibiotic prescribing and susceptibility trends of clinically significant Gram-negative bacilli (GNBs), along with the evolution of ASP strategies over time. Methods: We conducted a single-centre, retrospective observational study from 2011 to 2024. Antibiotic consumption, appropriateness, and susceptibility trends of six GNBs to seven commonly used antibiotics were analysed using the Kendall tau test to identify potential monotonic trends based on aggregated rather than patient-level data. Results: We demonstrated sustained improvement in appropriateness of seven broad-spectrum IV antibiotics, accompanied by significant reductions in IV ciprofloxacin, cefepime, and ertapenem use (p < 0.05). Hospital-wide susceptibility of six GNBs to all evaluated antibiotics improved significantly (p < 0.05), except for E. coli’s susceptibility to ertapenem and Enterobacterales’s susceptibility to ciprofloxacin. Conclusions: With an evolving, multi-pronged stewardship approach, antibiotic prescribing and GNB susceptibility to most antibiotics have improved. In a rapidly evolving healthcare landscape, ASPs must remain agile, continually refining priorities and employing innovative strategies.

Background/objectives: Studies evaluating the longitudinal impact (beyond a decade) of Antibiotic stewardship programs (ASP) strategies on the volume/quality of antibiotic prescriptions, as well as impact on antimicrobial resistance are lacking. Since 2008, the ASP at Singapore General Hospital had implemented various strategies in the following phases: 1) initiation; 2) expansion; 3) optimisation; and 4) innovation. In this study, we aim to evaluate the impact of ASP on the volume/quality of antibiotic prescribing and susceptibility trends of clinically significant Gram-negative bacilli (GNB). Methods: We conducted a single-center, retrospective observational study from 2011 to 2024. Antibiotic consumption, appropriateness and susceptibility trends of 6 GNBs to 7 commonly used antibiotics were analysed using Kendall tau test. Results: We demonstrated sustained improvement in appropriateness of 7 broad-spectrum IV antibiotics, accompanied by significant reductions in IV ciprofloxacin, cefepime and, ertapenem use (p < 0.05). Hospital-wide susceptibility of 6 GNBs to all evaluated antibiotics improved significantly (p < 0.05), except for E. coli susceptibility to ertapenem and Enterobacterales susceptibility to ciprofloxacin. Conclusion: An evolving multi-pronged antibiotic stewardship approach improved antibiotic prescribing and GNB susceptibility towards majority of the antibiotics. In a rapidly evolving healthcare landscape, ASPs must remain agile, continually refining priorities and employing innovative strategies.