Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem Resistant Gram-Negative Bacilli: An Interrupted Time-Series Analysis.

Teresa López-Viñau,Carmen De La Fuente,Luis Martínez-Martínez,Juan Castón,Elena Pérez-Nadales,José Rumbao Aguirre,José Del Prado,Irene Gracia-Ahufinger,Ángela Cano,Lucrecia García-Martínez,Montserrat Muñoz-Rosa,Germán Peñalva,José Cisneros,Elena García-Martínez,Inmaculada Salcedo,Julián Torre-Cisneros,Manuel Recio

doi:10.3390/antibiotics10050586

Abstract

Carbapenem-resistant Gram-negative bacilli (CR-GNB) are a critical public health threat, and carbapenem use contributes to their spread. Antimicrobial stewardship programs (ASPs) have proven successful in reducing antimicrobial use. However, evidence on the impact of carbapenem resistance remains unclear. We evaluated the impact of a multifaceted ASP on carbapenem use and incidence of CR-GNB in a high-endemic hospital. An interrupted time-series analysis was conducted one year before and two years after starting the ASP to assess carbapenem consumption, CR-GNB incidence, death rates of sentinel events, and other variables potentially related to CR-GNB incidence. An intense reduction in carbapenem consumption occurred after starting the intervention and was sustained two years later (relative effect −83.51%; 95% CI −87.23 to −79.79). The incidence density of CR-GNB decreased by −0.915 cases per 1000 occupied bed days (95% CI −1.743 to −0.087). This effect was especially marked in CR-Klebsiella pneumoniae and CR-Escherichia coli, reversing the pre-intervention upward trend and leading to a relative reduction of −91.15% (95% CI −105.53 to −76.76) and −89.93% (95% CI −107.03 to −72.83), respectively, two years after starting the program. Death rates did not change. This ASP contributed to decreasing CR-GNB incidence through a sustained reduction in antibiotic use without increasing mortality rates.

Highlights

The increase in carbapenem-resistant Gram-negative bacilli (CR-GNB), in particular Enterobacteriaceae, is a growing public health problem worldwide and has led to the development of coordinated and comprehensive global action plans [1,2]
The implementation of PROVAUR was associated with a long-term reduction in carbapenem consumption and the ATC-J01 group, with significant absolute and relative differences from the pre-intervention trend (Table 1, Figure 1)
This reduction was especially marked in carbapenems, which showed a rapid absolute decrease of −60.32 defined daily doses (DDD) per 1000 occupied bed days (OBD) one month after the beginning of the intervention, whose effect was maintained over time until reaching a relative reduction of −83.51% at the end of the two-year intervention period

Summary

Introduction

The increase in carbapenem-resistant Gram-negative bacilli (CR-GNB), in particular Enterobacteriaceae, is a growing public health problem worldwide and has led to the development of coordinated and comprehensive global action plans [1,2]. We study the efficacy and safety of PROVAUR to optimize the use of carbapenems and the impact of these measures on carbapenem resistance in all adult inpatient areas of a tertiary-care hospital with a high incidence of these microorganisms. We hypothesized that this program would lead to a reduction in carbapenem consumption and would reduce the incidence of CR-GNB, the endemic CR-Kp in our hospital, without increasing mortality rates

Methods

Results

Conclusion