Clinical and Microbiological Effects of an Antimicrobial Stewardship Program in Urology-A Single Center Before-After Study.

Ralf-Peter Vonberg,Madita Flintrop,Tobias Welte,Oana Joean,Ruxandra Sabau,Thorben Winkler,Jessica Rademacher,Markus A. Kuczyk,Daniel Tahedl

doi:10.3390/antibiotics11030372

Ralf-Peter Vonberg, Madita Flintrop + Show 7 more

Open Access

https://doi.org/10.3390/antibiotics11030372

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Abstract

Antimicrobial resistance is a major public health issue caused by antibiotic overuse and misuse. Antimicrobial stewardship (AMS) has been increasingly endorsed worldwide, but its effect has been studied scarcely in urologic settings. A before-after study was performed from 2018 through 2020 to evaluate changes in antimicrobial prescription, resistance rates and clinical safety upon implementation of an AMS audit and feedback program in the Urology Department of a large German academic medical center. The primary endpoints were safety clinical outcomes: the rate of infection-related readmissions and of infectious complications after transrectal prostate biopsies. Resistance rates and antimicrobial consumption rates were the secondary endpoints. The AMS team reviewed 196 cases (12% of all admitted in the department). The overall antibiotic use dropped by 18.7%. Quinolone prescriptions sank by 78.8% (p = 0.02) and 69.8% (p > 0.05) for ciprofloxacin and levofloxacin, respectively. The resistance rate of E. coli isolates declined against ceftriaxone (−9%), ceftazidime (−12%) and quinolones (−25%) in the AMS period. No significant increase in infection-related readmissions or infectious complications after prostate biopsies was observed (p = 0.42). Due to the potential to reduce antibiotic use and resistance rates with no surge of infection-related complications, AMS programs should be widely implemented in urologic departments.

Highlights

Antimicrobial resistance is an urgent global public health threat brought about by these drugs’ overuse and misuse [1,2]
Due to rapid environmental dissemination, antimicrobial resistance threatens to become a planetary health issue [7]. In response to this imminent danger, antimicrobial stewardship (AMS) programs were endorsed across the globe with the aim to achieve optimal clinical outcomes with minimal unintended antimicrobial effects like toxicities, selection and spread of resistant pathogens [8]
During the pre-AMS period, 1556 patients were hospitalized in the Urology Department, corresponding to 7242 patient days, and 75 patients had a transrectal prostate biopsy performed in the outpatient clinic

Summary

Introduction

Antimicrobial resistance is an urgent global public health threat brought about by these drugs’ overuse and misuse [1,2]. While they underpin all areas of modern medicine, antimicrobials’ inappropriate prescription and the subsequent resistance development have the potential to cause up to 10 million deaths by 2050 and to dramatically affect health-care systems and economies worldwide [3,4]. Due to rapid environmental dissemination, antimicrobial resistance threatens to become a planetary health issue [7] In response to this imminent danger, antimicrobial stewardship (AMS) programs were endorsed across the globe with the aim to achieve optimal clinical outcomes with minimal unintended antimicrobial effects like toxicities, selection and spread of resistant pathogens [8]. AMS programs include a set of actions that promote a responsible antimicrobials’ use at different public health levels [9]

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