Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem Resistant Gram-Negative Bacilli: An Interrupted Time-Series Analysis
| Autor: | Elena Pérez-Nadales, Julián Torre-Cisneros, José Ramón del Prado, Luis Martínez-Martínez, Lucrecia García-Martinez, Germán Peñalva, Angela Cano, Elena García-Martinez, José Miguel Cisneros, Inmaculada Salcedo, Manuel Recio, Juan José Castón, Teresa López-Viñau, José Rumbao Aguirre, Irene Gracia-Ahufinger, Montserrat Muñoz-Rosa, Carmen de la Fuente |
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| Přispěvatelé: | Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), Red Española de Investigación en Patología Infecciosa, European Commission, [López-Viñau,T, García-Martínez,L, Del Prado,JR] Pharmacy Unit, Reina Sofia University Hospital, Cordoba, Spain. [López-Viñau,T, Castón,JJ, Cano,Á, Recio,M, Pérez-Nadales,E, Torre-Cisneros,J] Infectious Diseases Unit, Reina Sofia University Hospital, Maimonides, Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba (UCO), Cordoba, Spain. [Peñalva,G, Cisneros,JM] Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, Virgen del Rocio University Hospital, Seville, Spain. [Muñoz-Rosa,M, Martínez-Martínez,L, Gracia-Ahufinger,I] Microbiology Unit, Reina Sofia University Hospital, IMIBIC, Department of Agricultural Chemistry, Edafology and Microbiology, University of Cordoba, Cordoba, Spain. [Rumbao Aguirre,J, García-Martínez,E] Hospital Management, Reina Sofia University Hospital, Cordoba, Spain. [Salcedo,I] Preventive Medicine Unit, Reina Sofia University Hospital, Cordoba, Spain. [de la Fuente,C] Intensive Care Unit, Reina Sofia University Hospital, Cordoba, Spain., This research was funded by the Plan Nacional de I + D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0008, RD16/0016/0009) co-financed by European Development Regional Fund ‘A way to achieve Europe’ and Operative program intelligent Growth 2014–2020, which did not participate in the development of the program or the analysis of its results. |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Carbapenem Carbapenem-resistant enterobacteriaceae Antimicrobial resistance Biochemistry Carbapenémicos Interrupted Time Series Analysis 0302 clinical medicine Information Science::Information Science::Data Collection::Vital Statistics::Morbidity::Incidence [Medical Subject Headings] Health Care::Environment and Public Health::Public Health [Medical Subject Headings] polycyclic compounds Medicine Antimicrobial stewardship Pharmacology (medical) 030212 general & internal medicine General Pharmacology Toxicology and Pharmaceutics Health Care::Health Care Facilities Manpower and Services::Health Facilities::Hospitals [Medical Subject Headings] Incidence (epidemiology) Mortality rate Carbapenemases Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Escherichia::Escherichia coli [Medical Subject Headings] Klebsiella pneumoniae Infectious Diseases carbapenem-resistant Enterobacteriaceae carbapenems Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Facultatively Anaerobic Rods::Enterobacteriaceae::Klebsiella::Klebsiella pneumoniae [Medical Subject Headings] Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents [Medical Subject Headings] Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Carbapenems [Medical Subject Headings] Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents [Medical Subject Headings] medicine.drug Microbiology (medical) medicine.medical_specialty carbapenemases 030106 microbiology Farmacorresistencia microbiana RM1-950 Microbiology Article 03 medical and health sciences Antibiotic resistance Carbapenem resistant Enterobacteriaceae Internal medicine Enterobacterias resistentes a carbapenémicos Antimicrobial stewardship program antimicrobial resistance Health Care::Health Care Quality Access and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Statistics as Topic::Regression Analysis [Medical Subject Headings] Programas de optimización del uso de los antimicrobianos antimicrobial stewardship program Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds 2-Ring::Quinolines [Medical Subject Headings] business.industry Gram negative bacilli biochemical phenomena metabolism and nutrition bacterial infections and mycoses Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Cephalosporins [Medical Subject Headings] Carbapenem-resistant Enterobacteriaceae Carbapenems Therapeutics. Pharmacology business |
| Zdroj: | Antibiotics Volume 10 Issue 5 Digital.CSIC. Repositorio Institucional del CSIC instname Antibiotics, Vol 10, Iss 586, p 586 (2021) |
| ISSN: | 2079-6382 |
| DOI: | 10.3390/antibiotics10050586 |
| Popis: | This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship. 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. This research was funded by the Plan Nacional de I + D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0008; RD16/0016/0009) co-financed by European Development Regional Fund ‘A way to achieve Europe’ and Operative program intelligent Growth 2014–2020, which did not participate in the development of the program or the analysis of its results. |
| Databáze: | OpenAIRE |
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