Current state of antimicrobial stewardship and organ transplantation in Thailand
Issued Date
2022-10-01
Resource Type
ISSN
13982273
eISSN
13993062
Scopus ID
2-s2.0-85139968707
Pubmed ID
36254509
Journal Title
Transplant Infectious Disease
Volume
24
Issue
5
Rights Holder(s)
SCOPUS
Bibliographic Citation
Transplant Infectious Disease Vol.24 No.5 (2022)
Suggested Citation
Chotiprasitsakul D., Bruminhent J., Watcharananan S.P. Current state of antimicrobial stewardship and organ transplantation in Thailand. Transplant Infectious Disease Vol.24 No.5 (2022). doi:10.1111/tid.13877 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/87227
Title
Current state of antimicrobial stewardship and organ transplantation in Thailand
Author's Affiliation
Other Contributor(s)
Abstract
Background: Antimicrobial stewardship (AMS) is a coherent set of actions to optimize antimicrobial use, improve patient outcomes, and reduce antimicrobial resistance (AMR). Thailand's national strategic plan has included AMS since 2017. Due to an increased risk of infection and AMR, solid organ transplant (SOT) recipients can benefit from antimicrobial stewardship programs (ASPs). However, the AMS in SOT has not been well defined. Balancing ASPs with the need for early and frequent antimicrobial treatment in this population is challenging. This review assesses the barriers and potential strategies of AMS in SOT in the setting of Thailand. Methods: We used PubMed to identify published articles on AMS in organ transplantation in Thailand from January 2013 to January 2022. We also searched local literature and local data from Google Scholar and Google. Finally, we described the AMS experience at Ramathibodi hospital as a proxy for transplant centers in Thailand. Results: There was no specific article on AMS in SOT in Thailand. At our hospital, ASPs have been part of the hospital's routine patient care, including the practice in the transplant unit. Modifiable challenges to AMS in SOT include prescriber opposition, diagnosis uncertainty, and lack of high quality. Both systems and individualized approaches should be implemented to overcome these barriers. The potential interventions include shortening antibiotic time-out, updating clinical guidelines, continuing education, handshake ASP, adopting new technology, and further research. Conclusions: There are limited data on AMS in organ transplantation in Thailand. Strategic priorities should focus on modifiable barriers tailored to organ transplantation. Quality improvement should be ensured by process and outcome measures.