Singapore stays steadfast in antimicrobial stewardship amid pandemic

Despite the novel coronavirus disease (COVID-19) pandemic, patterns and quality indicators of antimicrobial prescription did not change in Singapore, according to a new study.

“The sustainable culture of judicious antimicrobial use was developed over the years at our institutions. This could have contributed to continued practice of appropriate prescribing,” the researchers said, pointing out that their stewardship programme has been in place since 2009.

“Collectively, the antimicrobial stewardship (AMS) efforts over the years could have paid dividends during the time of COVID-19 pandemic. The maturity of antimicrobial prescribing habits may have sustained the practices even when AMS resources were substantially reduced,” they added.

In accordance with the Global Pont Prevalence Survey (Global-PPS) methodology, the researchers surveyed acute inpatients with COVID-19 to assess antimicrobial prescription and compared findings against the 2015, 2017, 2018, and 2019 results. They found that the prevalence of antimicrobial use dropped significantly over the years (p=0.02). [Antimicrob Resist Infect Control 2021;10:28]

For instance, 55 percent of patients were on these medications in 2015, which had decreased to 45 percent by 2017. Following a slight spike to 50 percent in 2018, rates again declined to 49 percent and 47 percent in 2019 and 2020, respectively.

The prescription of antimicrobials for systemic use also showed a similar pattern, plunging from 54 percent in 2015 to 42 percent in 2020 (p<0.001). In infectious disease wards, only 29 percent of patients were on antimicrobials in 2020.

These changes occurred despite the COVID-19 pandemic, which diverted resources away from the existing AMS programmes and systems in Singapore. “Despite the redeployment of our AMS manpower, the prevalence of antimicrobial and antibacterial use did not increase,” the researchers said.

Similarly, quality indicators did not suffer despite the pandemic. Documentation of reasons for prescribing antimicrobials, for example, improved from 91 percent in 2015 to 94 percent in 2020; this upward trend was unimpeded in 2020, reaching 97 percent (p<0.01 for trend). The documentation of stop/review dates also increased from 53 percent in 2015 to 56 percent in 2019, and then to 61 percent in 2020 (p_trend<0.01).

Overall compliance to prescribing guidelines dipped from 71 percent to 2015 to 62 percent in 2019; rates rebounded to 73 percent in 2020, further suggesting no deterioration in AMS amid the pandemic (p_trend=0.08).

“Despite a smaller AMS team, the presence of an established multidisciplinary AMS programme prior to the COVID-19 pandemic managed to keep antimicrobial prevalence and quality of antimicrobial prescribing stable in our institutions,” the researchers said, noting that “[a]s the pandemic continues, attention must be given to control the amount and appropriateness of antimicrobial use.”

“As the global momentum of controlling antimicrobial resistance accumulate in last few years, careful and deliberate actions must be taken now so that the COVID-19 pandemic does not derail this process,” they added.