Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis
Author:
Molina José1, Peñalva Germán1, Gil-Navarro María V2, Praena Julia2, Lepe José A1, Pérez-Moreno María A2, Ferrándiz Carmen3, Aldabó Teresa3, Aguilar Manuela1, Olbrich Peter4, Jiménez-Mejías Manuel E1, Gascón María L3, Amaya-Villar Rosario3, Neth Olaf4, Rodríguez-Hernández María J1, Gutiérrez-Pizarraya Antonio1, Garnacho-Montero José5, Montero Cristina6, Cano Josefina6, Palomino Julián1, Valencia Raquel1, Álvarez Rocío1, Cordero Elisa1, Herrero Marta1, Cisneros José M1, M J, P G, G N M V, Praena J, L J A, P M M A, F C, A T, A M, O P, J M M E, G M L, A V R, N O, R H M J, G P A, G M J, M C, C J, Palomino J, V R, A R, C E, H M, C J M, García-Cabrera Emilio, Porras Francisco, Jiménez-Parrilla Francisco, Obando Ignacio, Ruiz-Pérez Maite, Aznar Javier, Conde Manolo, Ortiz Carlos, Docobo Fernando, Bautista Javier,
Affiliation:
1. Departments of Infectious Diseases, Microbiology and Preventive Medicine, 2. Pharmacy 3. Critical Care 4. Pediatric Infectious Diseases and Immunodeficiency, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville 5. Department of Critical Care, University Hospital Virgen Macarena, University of Seville 6. Department of Pediatric Critical Care and Emergency, University Hospital Virgen del Rocio, Seville, Spain
Abstract
Abstract
Background
The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved.
Methods
We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs).
Results
A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, −216.8 defined daily doses per 1000 OBDs; 95% confidence interval, −347.5 to −86.1), and was sustained during subsequent years (average reduction, −19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, −.003 to .039) reverted toward a decreasing trend of −0.130 per quarter (change in slope, −0.029; −.051 to −.008), and so did the mortality rate (change in slope, −0.015; −.021 to −.008).
Conclusions
This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Microbiology (medical)
Cited by
58 articles.
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