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Open Access Letter to the Editor

Specialist trainees on rotation cannot replace dedicated consultant clinicians for antimicrobial stewardship of specialty disciplines

Chay Leng Yeo1, Jia En Wu1, Gladys Wei-Teng Chung1, Douglas Su-Gin Chan2, Dale Fisher3 and Li Yang Hsu34*

Author Affiliations

1 Department of Pharmacy, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

2 Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

3 Department of Medicine, National University Health System, NUHS Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore

4 Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore, 117597, Singapore

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Antimicrobial Resistance and Infection Control 2012, 1:36  doi:10.1186/2047-2994-1-36

Published: 17 November 2012

Abstract

Our prospective-audit-and-feedback antimicrobial stewardship (AS) program for hematology and oncology inpatients was switched from one led by dedicated clinicians to a rotating team of infectious diseases trainees in order to provide learning opportunities and attempt a “de-escalation” of specialist input towards a more protocol-driven implementation. However, process indicators including the number of recommendations and recommendation acceptance rates fell significantly during the year, with accompanying increases in broad-spectrum antibiotic prescription. The trends were reversed only upon reverting to the original setup. Dedicated clinicians play a crucial role in AS programs involving immunocompromised patients. Structured training and adequate succession/contingency planning is critical for sustainability.

Keywords:
Antimicrobial stewardship; Antimicrobial resistance; Trainee supervision; Compliance