Abstract
Multiple modes of interventions are available when implementing an antibiotic stewardship program (ASP), however, their complementarity has not yet been assessed. In a 938-bed hospital, we sequentially implemented four combined modes of interventions over one year, centralized by one infectious diseases specialist (IDS): (1) on-request infectious diseases specialist consulting service (IDSCS), (2) participation in intensive care unit meetings, (3) IDS intervention triggered by microbiological laboratory meetings, and (4) IDS intervention triggered by pharmacist alert. We assessed the complementarity of the different cumulative actions through quantitative and qualitative analysis of all interventions traced in the electronic medical record. We observed a quantitative and qualitative complementarity between interventions directly correlating to a decrease in antibiotic use. Quantitatively, the number of interventions has doubled after implementation of IDS intervention triggered by pharmacist alert. Qualitatively, these kinds of interventions led mainly to de-escalation or stopping of antibiotic therapy (63%) as opposed to on-request IDSCS (32%). An overall decrease of 14.6% in antibiotic use was observed (p = 0.03). Progressive implementation of the different interventions showed a concrete complementarity of these actions. Combined actions in ASPs could lead to a significant decrease in antibiotic use, especially regarding critical antibiotic prescriptions, while being well accepted by prescribers.
Highlights
In 2015 in Europe, 671,689 cases of infections with antibiotic-resistant bacteria features occurred, leading to 33,110 deaths, corresponding to 6.44 deaths per 100,000 population and 874,541 disability adjusted life-years (DALYs) [1]
Antibiotic use was significantly decreased by 14.6% in the whole hospital after antibiotic stewardship program (ASP)
There was a significant decrease of fluoroquinolones use of 63% (51 DDD1000PD in 2017 versus 19 DDD1000PD in 2019; p = 0.03) (Figure 5)
Summary
In 2015 in Europe, 671,689 cases of infections with antibiotic-resistant bacteria features occurred, leading to 33,110 deaths, corresponding to 6.44 deaths per 100,000 population and 874,541 disability adjusted life-years (DALYs) [1]. The current state could worsen exponentially with 390,000 deaths every year expected in Europe by 2050. This concerning healthcare issue represents a dramatic economic burden; that is, if the antibiotic-resistant bacteria infection rate remains at the same level as today, this could lead to a loss of 100 trillion of USD. Many studies have shown the positive impact of antibiotic stewardship programs (ASPs) on antibiotic use and antibiotic resistance, improvement of morbidity and mortality, reduction of Clostridium difficile infections incidence, and health costs savings [7,8,9,10,11,12,13]. One of the key points of ASP success is to gather a multidisciplinary team including pharmacists, microbiologists, and infectious diseases physicians with a specific time dedicated to this task [5,14,15]
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