{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:43:47Z","timestamp":1759970627451,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T00:00:00Z","timestamp":1737676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Antimicrobial resistance is a global health threat and Fiji is not exempt. The appropriate prescribing and timely de-escalation of antibiotics as an integral component of antimicrobial stewardship has been recently introduced in Fiji to help curb antimicrobial resistance through de-escalation, leading to a reduced opportunity for the induction of resistance. Objectives: To assess whether empirical antibiotics are being adjusted in a timely fashion in patients admitted with a diagnosis of suspected infection in the Colonial War Memorial Hospital( CMWH) over three months. Method: The study was undertaken on patients admitted to the acute medical ward and intensive care unit of the CWMH in Suva (Fiji\u2019s largest hospital). A total of 474 patients were prospectively enrolled at admission when prescribed empiric antibiotic therapy for suspected infections between February and April 2019. Results: A total of 356 patients admitted to the Acute Medical Ward and 118 admitted to the Intensive Care Unit were prescribed empiricalantibiotics. These 474 patients were prospectively observed to determine the factors influencing the extent and the timing of antibiotic de-escalation. Only 137 (29%) patients had their antibiotic regimen de-escalated in the first 72 h post-admission based on their microbiological results, whereas, 207 (42%) were de-escalated more than 72 h after admission (OR = 0.5, 95% CI 0.3\u20130.89; p &lt; 0.016). Conclusions: At CWMH, antibiotic de-escalation is slow and may be improved by quicker laboratory reporting, greater access to laboratory results for prescribers, and the availability of a wider range of narrow-spectrum antibiotics to assist de-escalation.<\/jats:p>","DOI":"10.3390\/antibiotics14020124","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T04:32:22Z","timestamp":1737693142000},"page":"124","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prospective Observational Study of De-Escalation of Empirical Antibiotics in Fiji\u2019s National Hospital"],"prefix":"10.3390","volume":"14","author":[{"given":"Tracey","family":"Young-Sharma","sequence":"first","affiliation":[{"name":"Medical Unit, Colonial War Memorial Hospital, Ministry of Health and Medical Services, Suva, Fiji"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shitanjni","family":"Wati","sequence":"additional","affiliation":[{"name":"Medical Unit, Colonial War Memorial Hospital, Ministry of Health and Medical Services, Suva, Fiji"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1809-5779","authenticated-orcid":false,"given":"Vikash","family":"Sharma","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi","family":"Naidu","sequence":"additional","affiliation":[{"name":"Medical Unit, Colonial War Memorial Hospital, Ministry of Health and Medical Services, Suva, Fiji"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Tong","sequence":"additional","affiliation":[{"name":"Fiji Pharmaceutical and Biomedical Services Centre, Ministry of Health and Medical Services, Suva, Fiji"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Jenney","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji"},{"name":"Microbiology Unit and Department of Infectious Diseases, The Alfred Hospital, Melbourne, VIC 3004, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,24]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2014). 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Hyg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1086\/598218","article-title":"Community-Associated Strains of Methicillin-Resistant Staphylococcus aureus and Methicillin-Susceptible S. aureus in Indigenous Northern Australia: Epidemiology and Outcomes","volume":"199","author":"Tong","year":"2009","journal-title":"J. Infect. Dis."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/2\/124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:35:16Z","timestamp":1759919716000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/2\/124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,24]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["antibiotics14020124"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14020124","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2025,1,24]]}}}