{"title":"巴林初级卫生保健中心抗菌药物管理方案的影响——5年经验","authors":"Jameela Alsalman , Mahmood Alawainati , Shereen Haji , Nour Shamas","doi":"10.1016/j.jiph.2025.102971","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial misuse globally challenges healthcare by driving resistance, escalating costs, and worsening outcomes. Antimicrobial stewardship (AMS) programs optimize use. This prospective interventional study outlines a five-year antimicrobial stewardship program (ASP) in Bahrain’s primary health care (PHC) facilities.</div></div><div><h3>Methods</h3><div>A prospective interventional study was conducted in Bahrain’s governmental PHC centers to evaluate the impact of a newly implemented ASP on antimicrobial use and cost. Starting in 2015, the ASP included a situational analysis of prescribing patterns and resources. A multidisciplinary team was formed to guide AMS activities, develop educational programs, establish clinical guidelines, create an electronic prescribing reporting system, and provide feedback on prescribing trends. The study analyzed antimicrobial prescription order reports and evaluated all antimicrobials prescribed between January 2016 and September 2021, assessing antimicrobial prescription per 1000 inhabitants, defined daily doses (DDD) per 1000 inhabitants, and antimicrobial costs.</div></div><div><h3>Results</h3><div>A total of 2032,653 prescription were ordered between January 2016 and September 2021, with penicillins (68.74 %), cephalosporins (18.13 %), and antiparasitics (9.43 %) being the most common. Over 70 % of the PHC prescriptions were from the WHO-recommended Access category for the whole study period. After AMS interventions, prescriptions decreased 4.5-fold, from 67.6 to 15.1 prescriptions per 1000 inhabitants, with statistically significant reductions (P < 0.001) in all antimicrobial classes except nitrofurantoin. The DDD/1000 inhabitants, and cost also decreased significantly (P < 0.001), saving around 4.1 million Bahraini Dinars, ($10.97 million).</div></div><div><h3>Conclusions</h3><div>The first published country wide ASP in primary health care in the Eastern Mediterranean significantly reduced antimicrobial prescriptions and DDD/ 1000 inhabitants. Leadership support, multifaceted interventions, and active multidisciplinary participation are key to sustaining and improving outcomes at a country scale. Further analysis can identify additional gaps and necessary system changes.</div></div>","PeriodicalId":16087,"journal":{"name":"Journal of Infection and Public Health","volume":"18 12","pages":"Article 102971"},"PeriodicalIF":4.0000,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of an antimicrobial stewardship program in primary health care centers in Bahrain – A 5-year experience\",\"authors\":\"Jameela Alsalman , Mahmood Alawainati , Shereen Haji , Nour Shamas\",\"doi\":\"10.1016/j.jiph.2025.102971\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Antimicrobial misuse globally challenges healthcare by driving resistance, escalating costs, and worsening outcomes. Antimicrobial stewardship (AMS) programs optimize use. This prospective interventional study outlines a five-year antimicrobial stewardship program (ASP) in Bahrain’s primary health care (PHC) facilities.</div></div><div><h3>Methods</h3><div>A prospective interventional study was conducted in Bahrain’s governmental PHC centers to evaluate the impact of a newly implemented ASP on antimicrobial use and cost. Starting in 2015, the ASP included a situational analysis of prescribing patterns and resources. A multidisciplinary team was formed to guide AMS activities, develop educational programs, establish clinical guidelines, create an electronic prescribing reporting system, and provide feedback on prescribing trends. The study analyzed antimicrobial prescription order reports and evaluated all antimicrobials prescribed between January 2016 and September 2021, assessing antimicrobial prescription per 1000 inhabitants, defined daily doses (DDD) per 1000 inhabitants, and antimicrobial costs.</div></div><div><h3>Results</h3><div>A total of 2032,653 prescription were ordered between January 2016 and September 2021, with penicillins (68.74 %), cephalosporins (18.13 %), and antiparasitics (9.43 %) being the most common. Over 70 % of the PHC prescriptions were from the WHO-recommended Access category for the whole study period. After AMS interventions, prescriptions decreased 4.5-fold, from 67.6 to 15.1 prescriptions per 1000 inhabitants, with statistically significant reductions (P < 0.001) in all antimicrobial classes except nitrofurantoin. The DDD/1000 inhabitants, and cost also decreased significantly (P < 0.001), saving around 4.1 million Bahraini Dinars, ($10.97 million).</div></div><div><h3>Conclusions</h3><div>The first published country wide ASP in primary health care in the Eastern Mediterranean significantly reduced antimicrobial prescriptions and DDD/ 1000 inhabitants. Leadership support, multifaceted interventions, and active multidisciplinary participation are key to sustaining and improving outcomes at a country scale. Further analysis can identify additional gaps and necessary system changes.</div></div>\",\"PeriodicalId\":16087,\"journal\":{\"name\":\"Journal of Infection and Public Health\",\"volume\":\"18 12\",\"pages\":\"Article 102971\"},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2025-09-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Infection and Public Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S187603412500320X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S187603412500320X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Impact of an antimicrobial stewardship program in primary health care centers in Bahrain – A 5-year experience
Background
Antimicrobial misuse globally challenges healthcare by driving resistance, escalating costs, and worsening outcomes. Antimicrobial stewardship (AMS) programs optimize use. This prospective interventional study outlines a five-year antimicrobial stewardship program (ASP) in Bahrain’s primary health care (PHC) facilities.
Methods
A prospective interventional study was conducted in Bahrain’s governmental PHC centers to evaluate the impact of a newly implemented ASP on antimicrobial use and cost. Starting in 2015, the ASP included a situational analysis of prescribing patterns and resources. A multidisciplinary team was formed to guide AMS activities, develop educational programs, establish clinical guidelines, create an electronic prescribing reporting system, and provide feedback on prescribing trends. The study analyzed antimicrobial prescription order reports and evaluated all antimicrobials prescribed between January 2016 and September 2021, assessing antimicrobial prescription per 1000 inhabitants, defined daily doses (DDD) per 1000 inhabitants, and antimicrobial costs.
Results
A total of 2032,653 prescription were ordered between January 2016 and September 2021, with penicillins (68.74 %), cephalosporins (18.13 %), and antiparasitics (9.43 %) being the most common. Over 70 % of the PHC prescriptions were from the WHO-recommended Access category for the whole study period. After AMS interventions, prescriptions decreased 4.5-fold, from 67.6 to 15.1 prescriptions per 1000 inhabitants, with statistically significant reductions (P < 0.001) in all antimicrobial classes except nitrofurantoin. The DDD/1000 inhabitants, and cost also decreased significantly (P < 0.001), saving around 4.1 million Bahraini Dinars, ($10.97 million).
Conclusions
The first published country wide ASP in primary health care in the Eastern Mediterranean significantly reduced antimicrobial prescriptions and DDD/ 1000 inhabitants. Leadership support, multifaceted interventions, and active multidisciplinary participation are key to sustaining and improving outcomes at a country scale. Further analysis can identify additional gaps and necessary system changes.
期刊介绍:
The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other.
The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners.
It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.