Carbapenem Appropriateness in KK Women’s and Children’s Hospital (KKH) Antimicrobial Stewardship Programme

The Infectious Disease Service at our hospital is the busiest and largest medical service in Singapore dedicated to treating children with severe and high-risk infections. Our clinics offer comprehensive travel health consultations, vaccination programmes, including both routine and for the immuno-compromised, as well as specialised care for children with HIV, Hepatitis B and C exposure.

As a national referral centre, our clinics manages BCG vaccines, tuberculosis (TB), non-tuberculous mycobacterial infections and the paediatric TB clinic at the National Tuberculosis Contact Clinic at Tan Tock Seng Hospital.

The service plays a crucial role in developing outbreak response protocols, contributing to national and hospital task force committees on Infection Control, bio-warfare surveillance, management and containment of hand-foot-mouth disease, AIDS, SARS, Antimicrobial Stewardship and immunization.

We are also actively involved in multiple trials as KKH is a surveillance site of severe infections and post-immunization adverse events in children.

Antimicrobials are critical for treating common and life-threatening conditions. Antimicrobial resistance is a growing threat to public health worldwide. Improving the way healthcare professionals prescribe antimicrobials help keep us healthy and reduces antimicrobial resistance, which ensures that these life-saving drugs will remain effective for future generations.

Appropriate use of antimicrobials is an essential part of patient safety. The Antimicrobial Stewardship Programme (ASP) team works closely with all healthcare professionals to develop and update hospital-wide antimicrobial guidelines based on current and evidence-based practices. We review the use of antimicrobials in KKH to target areas for improvement and provide regular educational updates to healthcare professionals.

Every patient who has been prescribed with selected broad-spectrum antibiotics (e.g. carbapenems) will be reviewed by the ASP team. We review the appropriateness of carbapenems upon initiation (“initial”) as well as throughout the antibiotic course (“overall”).

Since the introduction of ASP in KKH, initial and overall appropriateness of carbapenems has increased steadily from 75 – 80% and 50 – 70% in 2012 respectively, to 80-90% over the years. This is comparable to other similar institutions1. The graph below shows the initial and overall appropriateness of Carbapenem prescriptions in KKH from 2020 to 2024.

Conclusion

It is the policy of our hospital that all healthcare professionals are committed to prescribing antimicrobials appropriately. Antimicrobial Stewardship Programmes are crucial in combating antimicrobial resistance.

Reference(s):

Osowicki J, et al, Australia-wide point prevalence survey of the use and appropriateness of antimicrobial prescribing for children in hospital. Med J Aust. 2014. 201 (11); 657 – 62

Infectious Diseases - Carbapenem Appropriateness – Anti-microbial Stewardship Programme