02 Apr 2011
By: MELISSA PANG
SINGAPORE hospitals are working to squash the development of superbugs, which are micro- organisms that have become resistant to most antibiotics.
In the war against superbugs, Tan Tock Seng Hospital (TTSH) launched an Antimicrobial Stewardship Programme in 2009, which has helped reduce them.
Dr David Lye, a consultant at the hospital's department of infectious diseases, who is steering the project, shared the findings with media ahead of World Health Day next Thursday. The theme this year is antimicrobial resistance.
The programme, which includes guidelines on the use of antibiotics for patients and a computer system that provides advice on antibiotic prescriptions, has resulted in a 13 per cent fall in the use of a group of strong antibiotics.
Together with a hand-hygiene programme introduced in 2009, it led to the incidence of drug-resistant bacteria dropping by 36 per cent between January 2009 and December last year, said Dr Lye.
Antimicrobial resistance occurs when antibiotics are misused, for example when given unnecessarily or when an improper dosage or wrong type is given.
In these cases, micro-organisms such as bacteria and viruses change in ways that render medication ineffective. When they become resistant to most antibiotics, they become superbugs.
Ensuring antibiotics are accurately prescribed thus becomes crucial. About 20 per cent of the 200 antibiotic prescriptions daily are now ordered by TTSH doctors through the computerised program. More than half have used it at least once.
More importantly, despite the decreased use of antibiotics, there has been no rise in hospital deaths, said Dr Lye.
He added: "An evaluation of the program shows that it is as good as a doctor making a prescription. It is better at getting the right dose, and because guidelines are programmed into the system, it is better able to prescribe antibiotics that work against bacteria that cause infections in patients."
Another benefit is in terms of savings. The increase in antibiotic costs from 2008 to 2009 was $1.3 million; from last year to this year, it was $400,000. From April, TTSH will be expanding the computer system to spur greater use.
The Singapore General Hospital (SGH) and National University Hospital (NUH) also have such schemes.
At SGH, pharmacists and a doctor audit a list of the previous day's prescriptions. If any require fine-tuning, feedback will be given to the doctors so that changes can be done quickly, said Dr Maciej Piotr Chlebicki, a consultant at SGH's department of infectious diseases.
After the programme started, he added, there has been a drop in the prescription of five powerful antibiotics, without any compromise to patient safety.
NUH monitors the prescription and proper use of antibiotics in designated wards. Pharmacists will check if key prescribed antibiotics are used appropriately, and the infectious diseases team is consulted should a red flag be raised.
Associate Professor Dale Fisher, head and senior consultant at NUH's division of infectious diseases, said the hope is to move to an electronic system eventually.
Superbug infections are a growing problem worldwide. Last year, a new one from India caused alarm due to its ability to resist the most powerful antibiotics.
Last December, the Health Ministry here said the superbug was found in two patients earlier in the year, but was successfully dealt with.
Email: melpang@sph.com.sg
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