Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy
Impact of a mixed educational and semi-restrictive antimicrobial stewardship project in a large teaching hospital in Northern Italy
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DOI：
10.1007/s15010-017-1063-7
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发表时间：
2017-12-01
期刊：
影响因子：
7.5
通讯作者：
Viscoli, Claudio
中科院分区：
文献类型：
--
作者：
Giacobbe, Daniele Roberto;Del Bono, Valerio;Viscoli, Claudio
抗生素的过度使用有利于抗生素耐药性的传播，以及侵袭性真菌疾病和艰难梭菌感染（CDI）。在这项研究中，我们评估了混合教育和半限制性抗菌药物管理（AMS）项目在意大利的一家大型教学医院的影响。AMS项目于2014年5月至2016年4月进行。它包括两个连续阶段的两项举措：（1）教育活动;（2）通过计算机化软件对抗菌药物处方进行半限制性控制。主要终点是抗菌药物和抗真菌药的消耗。次要终点是CDI、耐甲氧西林金黄色葡萄球菌（MRSA）血流感染（BSI）、耐碳青霉烯类肺炎克雷伯菌（CRKP）BSI和念珠菌BSI的发生率。在研究期间，观察到抗菌药物的消耗量在统计学上显着减少（-1.45限定日剂量（DDD）/每月1000患者-天，95%置信区间[CI] -2.38至-0.52，p 0.004），主要由氟喹诺酮类、第三代/第四代头孢菌素的使用减少驱动，和碳青霉烯类。未观察到抗真菌药消耗量减少（每月-0.04 DDD/1000患者-天，95% CI -0.34至+0.25，p 0.750）。观察到CRKP BSI发生率呈统计学显著性降低趋势（发生率比0.96，95% CI 0.92-0.99，p 0.013）。CDI、MRSA BSI和念珠菌BSI的趋势无统计学显著性差异。混合AMS项目可有效减少主要抗菌药物的使用和CRKP BSI的发生率。需要进一步研究，以评估半限制性方法的长期效益。
The overuse of antimicrobials favors the dissemination of antimicrobial resistance, as well as invasive fungal diseases and Clostridium difficile infections (CDI). In this study, we assessed the impact of a mixed educational and semi-restrictive antimicrobial stewardship (AMS) project in a large teaching hospital in Italy.The AMS project was conducted from May 2014 to April 2016. It consisted of two initiatives in two consecutive periods: (1) educational activities; (2) semi-restrictive control of antimicrobial prescribing through a computerized software. The primary endpoint was consumption of antibacterials and antifungals. Secondary endpoints were incidence of CDI, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI), carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI, and Candida BSI.During the study period, a statistically significant reduction in consumption was observed for antibacterials (-1.45 defined daily doses (DDD)/1000 patient-days monthly, 95% confidence intervals [CI] -2.38 to -0.52, p 0.004), mainly driven by reductions in the use of fluoroquinolones, third/fourth generation cephalosporins, and carbapenems. No decrease in consumption of antifungals was observed (-0.04 DDD/1000 patient-days monthly, 95% CI -0.34 to +0.25, p 0.750). A statistically significant trend towards reduction was observed for incidence of CRKP BSI (incidence rate ratio 0.96, 95% CI 0.92-0.99, p 0.013). No statistically significant variations in trends were observed for CDI, MRSA BSI, and Candida BSI.The mixed AMS project was effective in reducing the use of major antibacterials and the incidence of CRKP BSI. Further research is needed to assess the extent of long-term benefits of semi-restrictive approaches.