Impact of an empiric antimicrobial therapy manual on antimicrobial usage and multidrug resistant organism trends in a large Italian teaching hospital. Issue 2 (June 2022)

• Record Type: Journal Article
• Authors: Corcione, Silvia; Shbaklo, Nour; Vicentini, Costanza; Corradi, Alessio; Scabini, Silvia; Pinna, Simone Mornese; Tarozzo, Alessia; Curtoni, Antonio; Cattel, Francesco; Cavallo, Rossana; Zotti, Carla M.; Raciti, Ida Marina; Silvestre, Carlo; Scaglione, Luca; De Rosa, Francesco Giuseppe
• Is Part Of: Infection Prevention in Practice. Volume 4:Issue 2(2022)
• Publication Date: 2022-06
• Subjects: Antimicrobial stewardship -- Multidrug resistant organism -- Antibiotics; Infection -- Prevention -- Periodicals; Infection Control; Infection -- Prevention; Electronic journals; Periodical; Electronic journals; Periodicals; 616.9045
• DOI: 10.1016/j.infpip.2021.100187
• Languages: English
• ISSNs: 2590-0889

Abstract

Summary: Aim: To evaluate the changes in antimicrobial consumption and multidrug-resistant microorganism trends after introducing an empiric antimicrobial therapy manual to support antimicrobial stewardship. Methods: A 4-year prospective interventional study assessed the effect of introducing an empiric antimicrobial therapy manual in medical and surgical wards during two periods: pre-intervention period (January 2015–May 2017) and post-intervention period (June 2017–December 2019). Outcomes included microorganism trends of bloodstream infections (BSI) for Klebsiella pneumoniae carbapenemase-producing bacteria (KPC), extended spectrum beta-lactamase ESBL- E. coli, meticillin-resistant Staphylococcus aureus (MRSA) and Candida albicans . Also, Clostridioides difficile infection (CDI) episodes were included. Rates were normalised per 1000 patient-days (PD). Antimicrobial consumption was assessed as defined daily dose (DDD)/1000 PD in interrupted time series analysis. Results: In medical wards, we observed a significant decrease in the consumption of piperacillin-tazobactam and a decrease in the trends of tigecycline and vancomycin consumption. In surgical wards, there was a significant decrease in consumption of fluoroquinolones and piperacillin-tazobactam. This decrease was maintained in trend for all the antimicrobials but was significant for tigecycline only. In medical wards, there was a significant reduction of MRSA and C. albicans . In surgical wards, we observed a decrease in MRSA, ESBL- E. coli, C. albicans and CDI. KPC cases decreased by 22.5% in medical wards and 74.3% in surgical wards. Conclusion: The results suggest that a persuasive educational approach to antimicrobial stewardship, with the introduction of an empiric antimicrobial manual and continuous education, resulted in reductions in both antimicrobial use and healthcare-associated BSI caused by multidrug-resistant organisms. More studies with longer follow up are needed to investigate the effect of antimicrobial stewardship on clinical outcomes.