Reducing inappropriate antimicrobial use for inpatients with community-acquired pneumonia with a tailor-made antimicrobial stewardship programme

Context

Antimicrobial resistance (AMR) is a growing public health threat in Cambodia, affecting lifesaving medical procedures and posing socio-economic challenges. The emergence of multidrug-resistant organisms has been documented, and respiratory infections rank high in mortality rates. With limited healthcare resources and a low physician-to-population ratio, the need for effective antimicrobial stewardship is urgent. Recent national policies aim to address AMR, but implementation remains a challenge due to resource constraints and limited laboratory capabilities.

Problem

Inappropriate antimicrobial use is prevalent in Cambodian hospitals, exacerbated by factors such as structural, operational and behavioral challenges, including the lack of clear AMS task description, resources and capacity, standard operating procedures and necessary clinical guidelines for AMS program implementation. Despite some progress, the lack of established antimicrobial stewardship programs and a reliance on empiric treatment hinder effective management of infections like pneumonia. This project seeks to address these gaps by implementing a tailored AMS program specifically focused on pneumonia in medical wards.

Project Overview

This is a 3-year intervention and implementation research project that include two major components:

1. a component to develop and implement of a tailor-made hospital-based AMS program, the AMS intervention package, in six selected hospitals
2. a research component to monitor, cost, evaluate to generate evidence and promote the evidence use for scaling up.

The AMS intervention package includes:

• creating an AMS management structure and a multidisciplinary AMS team with clear terms of reference
• developing a standard operating procedures for the hospital AMS program
• developing and introducing clinical guidelines for CAP to AMS team and other relevant hospital staff
• setting up a minimum AMS data collection and monitoring
• providing AMS training and coaching to the AMS team to enable them to train other relevant hospital staff and lead hospital AMS core activities, including educational meetings, and audit with feedback.

Outcomes

1. Analyse organizational capacity and contextual barriers for AMS implementation.
2. Develop SOPs and clinical protocols for AMS.
3. Implement AMS protocols in selected hospitals.
4. Assess the effectiveness, acceptability, and costs of the AMS intervention.
5. Inform policy makers of the cost effectiveness of the intervention by providing proof of concept.