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Olivieri R, Vannini P, Corzani A, Bianco MT, Franchi F, Cusi MG, Scolletta S, Arena F, Basagni C, Gusinu R, Tumbarello M. Rapid Decrease in Fluoroquinolones Consumption following Implementation of a Simple Antimicrobial Stewardship Bundled Intervention in a University Hospital during the COVID-19 Pandemic. Antibiotics (Basel) 2023; 12:antibiotics12040694. [PMID: 37107056 PMCID: PMC10135293 DOI: 10.3390/antibiotics12040694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Fluoroquinolones (FQs) represent an class of antibiotics of medical importance, but their use has been restricted due to their ecologic impact and associated side effects. The reduction of FQs use is an important goal of antimicrobial stewardship programs (ASP). This work describes an ASP focused on overall antibiotics and FQs consumption reduction. From January 2021, an ASP was implemented in a 700-bed teaching hospital. The ASP was based on: (i) antibiotics consumption monitoring system (DDD/100 bed days); (ii) mandatory antibiotic prescription-motivation (using a dedicated informatic format) with the goal of >75% of motivated prescriptions; and (iii) data feedback and training on FQs use indications. We evaluated the impact of the intervention on overall systemic antibiotics and FQs consumption according to the objectives posed by Italian PNCAR (National Action Plan on Antimicrobial Resistance). A decrease of 6.6% in antibiotic use was observed (2019 vs. 2021). Notably, the FQs consumption fell by 48.3% from 7.1 DDD/100 bd in 2019 to 3.7 DDD/100 bd in 2021 (p < 0.001). After six months of mandatory antibiotic prescription-indication, all units achieved the target set. The study suggests that a simple, bundled ASP intervention can be rapidly effective obtaining the objectives of PNCAR on the reduction of overall antibiotics and FQs consumption.
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Affiliation(s)
- Raffaela Olivieri
- Healthcare-Associated Infections Control Unit, Siena University Hospital, 53100 Siena, Italy
| | - Paola Vannini
- Health Service Management Board, Siena University Hospital, 53100 Siena, Italy
| | - Alice Corzani
- Pharmacy Unit, Siena University Hospital, 53100 Siena, Italy
| | | | - Federico Franchi
- Anesthesia and Intensive Care Unit, Department of Cardiac, Thoracic, Vascular Sciences, Siena University Hospital, 53100 Siena, Italy
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Maria Grazia Cusi
- Microbiology and Virology Unit, Department of Innovation, Experimentation and Clinical Research, Siena University Hospital, 53100 Siena, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Sabino Scolletta
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
- Anesthesia and Intensive Care Unit, Department of Emergency-Urgency and Organ Transplantation, Siena University Hospital, 53100 Siena, Italy
| | - Fabio Arena
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
- IRCCS Don Carlo Gnocchi Foundation, 50143 Florence, Italy
| | - Claudia Basagni
- Health Service Management Board, Siena University Hospital, 53100 Siena, Italy
| | - Roberto Gusinu
- Health Service Management Board, Siena University Hospital, 53100 Siena, Italy
| | - Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
- Infectious and Tropical Diseases Unit, Department of Medical Sciences, Siena University Hospital, 53100 Siena, Italy
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Jeanvoine A, Bouxom H, Leroy J, Gbaguidi-Haore H, Bertrand X, Slekovec C. Resistance to third-generation cephalosporins in Escherichia coli in the French community: The times they are a-changin'? Int J Antimicrob Agents 2020; 55:105909. [DOI: 10.1016/j.ijantimicag.2020.105909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/17/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022]
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Strazzulla A, Bokobza S, Ombandza E, Kherallah K, Hommel S, Draidi R, Bonutto C, Zamponi DB, Gauzit R, Diamantis S. Impact of an Antimicrobial Stewardship Program on Resistance to Fluoroquinolones of Urinary Enterobacteriaceae Isolated From Nursing Home Residents: A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 21:1322-1326. [PMID: 32199718 DOI: 10.1016/j.jamda.2020.01.111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study investigated the impact of an antimicrobial stewardship program on fluoroquinolone (FLQ) resistance in urinary Enterobacteriaceae isolated from residents of 3 French nursing homes. DESIGN A multicentric retrospective before-and-after study was conducted. SETTING AND PARTICIPANTS All the first urinary Enterobacteriaceae isolates obtained from nursing home residents were included. Two time frames were analyzed: 2013-2015 and 2016-2017. METHODS The antimicrobial stewardship program started in 2015 and was based on (1) 1-day training for use of an "antimicrobial stewardship kit for nursing homes;" and (2) daily support and training of the coordinating physician by an antibiotic mobile team (AMT) in 2 of 3 nursing homes. RESULTS Overall, 338 urinary isolates were analyzed. Escherichia coli was the most frequent species (212/338, 63%). A significant reduction of resistance to ofloxacin was observed between 2013-2015 and 2016-2017 in general (Δ = -16%, P = .004) and among isolates obtained from patients hospitalized in the county nursing home with AMT support (Δ = -28%, P < .01). A nonstatistically significant reduction in ofloxacin resistance was also observed in the hospital nursing home with AMT support (Δ = -18%, P = .06). CONCLUSIONS AND IMPLICATIONS Our antimicrobial stewardship program resulted in a decrease in resistance to FLQ among urinary Enterobacteriaceae isolated from nursing home residents. The support of an AMT along with continuous training of the coordinating physician seems to be an important component to ensure efficacy of the intervention.
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Affiliation(s)
- Alessio Strazzulla
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France; Internal Medicine Unit, Groupe Hospitalier Sud Ile de France, Melun, France.
| | | | | | | | | | - Raouf Draidi
- Antibiotic Mobile Team, Hospital of Provins, France
| | | | - Dominique Bonnet Zamponi
- Observatoire du Médicament des Dispositifs Médicaux et de l'Innovation Thérapeutique, Paris, France
| | - Rémy Gauzit
- Antibiotic Mobile Team, Cochin University Hospital, Paris, France
| | - Sylvain Diamantis
- Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France
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