Abstract
Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.
Highlights
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.Antimicrobial resistance is a threat to global public health and many countries reaffirm their commitment to develop national action plans to deal with the problem, establishing, among other measures, systems to guarantee a more appropriate use of antibiotics [1].Antimicrobial overuse and inappropriate use remain significant problems and, the highest consumption of antibiotics is at the outpatient level, most studies on the impact of antimicrobial stewardship programs (ASP) focused on the hospital setting, where patients are subjected to a higher pressure of antibiotic treatment and there is a greater risk of transmission of resistance.Antimicrobial stewardship are quality improvement programs that include heterogeneous interventions [2]
The implementation of these ASP has shown a significant reduction of antibiotic use and hospital costs [3], but few studies refer to the impact on clinical outcome [4], antibiotic resistance [5,6], or incidence of Clostridioides difficile infection [7]
The acceptance of the intervention made by infectious diseases physician decreased days of treatment, inpatients days, and the incidence of candidemia and hospital-acquired bloodstream infections (BSIs) caused by MDR bacteria, despite having increased somewhat the consumption of other antibiotics that have a lower ecological impact
Summary
Antimicrobial overuse and inappropriate use remain significant problems and, the highest consumption of antibiotics is at the outpatient level, most studies on the impact of antimicrobial stewardship programs (ASP) focused on the hospital setting, where patients are subjected to a higher pressure of antibiotic treatment and there is a greater risk of transmission of resistance. Antimicrobial stewardship are quality improvement programs that include heterogeneous interventions [2]. The implementation of these ASP has shown a significant reduction of antibiotic use and hospital costs [3], but few studies refer to the impact on clinical outcome [4], antibiotic resistance [5,6], or incidence of Clostridioides difficile infection [7]. Interventions are generally more effective in prospective studies with clinical feedback on prescribing, but there are few studies of this type that cover the entire hospital with a duration long enough in time to evaluate the persistence of their effect [8,9]
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