The effect of an antimicrobial stewardship programme in two intensive care units of a teaching hospital: an interrupted time series analysis. (June 2020)

• Record Type: Journal Article
• Authors: Onorato, L.; Macera, M.; Calò, F.; Monari, C.; Russo, F.; Iovene, M.R.; Signoriello, G.; Annibale, R.; Pace, M.C.; Aurilio, C.; Gaeta, G.B.; Coppola, N.
• Is Part Of: Clinical microbiology and infection. Volume 26:Number 6(2020)
• Page Start: 782.e1
• Page End: 782.e6
• Publication Date: 2020-06
• Subjects: Antibiotics -- Antimicrobial stewardship -- Bacteraemia -- Bacterial resistances -- Defined daily dose -- Intensive care units; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2019.10.021
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: To evaluate the effect of an antimicrobial stewardship programme in two intensive care units (ICUs) of a teaching hospital. Methods: Between January 2017 and June 2018 we conducted a prospective, interventional, interrupted time-series study, based on Prospective Audit and Feedback in two ICUs of an acute-care teaching hospital. The primary outcomes were the difference in the antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms. The secondary outcomes included the hospital mortality rate, the mean length of stay and the antibiotic expense. Results: During the study, 231 audits were performed, evaluating 693 antibiotic prescriptions. The programme led to a global reduction in antibiotic consumption, with a change in level (CL) of –324.8 defined daily doses (DDD)/100 patient-days (PD), p 0.04, and particularly in the use of fluoroquinolone: (CL: –63.48 DDD/100 PD, p < 0.001). A non-significant reduction was obtained for the consumption of carbapenems (CL: –34.7 DDD/100 PD, p 0.25) and third- and fourth-generation cephalosporins (CL: –27.3 DDD/100 PD, p 0.102). Furthermore, we registered a significant decrease in all BSI (CL: –5.8 events/100 PD, p 0.026) and in BSI due to MDR Gram-negative organisms (CL: –2.96 events/100 PD, p 0.043). No difference was observed in the hospital mortality and length of stay. Conclusions: Our study demonstrated that implementation of an antimicrobial stewardship programme in two ICUs of a teaching hospital induced a significant reduction in antibiotic consumption and in the incidence of BSI due to MDR Gram-negative organisms, without any impact on the mortality rate.