1
|
Martín-Gutiérrez G, Peñalva G, Ruiz-Pérez de Pipaón M, Aguilar M, Gil-Navarro MV, Pérez-Blanco JL, Pérez-Moreno MA, Amaya-Villar R, Ferrándiz-Millón C, Gascón ML, Goycochea-Valdivia WA, Jiménez-Mejías ME, Navarro MD, Lepe JA, Alvarez-Marín R, Neth O, Guisado-Gil AB, Infante-Domínguez C, Molina J, Cisneros JM. Efficacy and safety of a comprehensive educational antimicrobial stewardship program focused on antifungal use. J Infect 2020; 80:342-349. [PMID: 31954101 DOI: 10.1016/j.jinf.2020.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Few data exist regarding the impact of antimicrobial stewardship programs on antifungal use. We evaluated the efficacy and safety of a comprehensive long-term antimicrobial stewardship program (ASP) focused on antifungal use. METHODS During a 9-year period, we quarterly assessed antifungal consumption, incidence density of hospital-acquired candidemia, Candida spp. distribution, antifungal resistance, and crude death rate per 1000 occupied bed days (OBDs) of hospital-acquired candidemia. We performed segmented regression analysis of interrupted time series. RESULTS A significant change in trend was observed for antifungal consumption, with a sustained reduction of -0.87% per quarter (95% confidence interval [CI], -1.36 -0.38, p < 0.001), accounting for a final reduction of -38.4%. The main reduction was produced in fluconazole, with a sustained reduction of -1.37% per quarter (95%CI, -1.96 -0.68, p<0.001). The incidence density of hospital-acquired candidemia decreased, with a change in slope of -5.06% cases per 1000 OBDs per year (95%CI, -8.23 -1.77, p = 0.009). The 14-day crude death rate per 1000 OBDs dropped from 0.044 to 0.017 (-6.36% deaths per 1000 OBDs per year; 95%CI, -13.45 -1.31, p = 0.09). CONCLUSIONS This ASP has succeeded in optimizing the use of antifungal with a long-lasting reduction without increasing the incidence, neither the mortality, of hospital-acquired candidemia.
Collapse
Affiliation(s)
- Guillermo Martín-Gutiérrez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Germán Peñalva
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Maite Ruiz-Pérez de Pipaón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Manuela Aguilar
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - María Antonia Pérez-Moreno
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | | | | | - María L Gascón
- Intensive Care Department, University Hospital Virgen del Rocío, Seville, Spain
| | - Walter A Goycochea-Valdivia
- Pediatric Infectious Diseases and Immunodeficiency, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Manuel E Jiménez-Mejías
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - María Dolores Navarro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - José A Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Rocío Alvarez-Marín
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Olaf Neth
- Pediatric Infectious Diseases and Immunodeficiency, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Ana B Guisado-Gil
- Clinical Pharmacy Service, University Hospital Virgen del Rocío, Seville, Spain
| | - Carmen Infante-Domínguez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - José Molina
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - José M Cisneros
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain.
| | | |
Collapse
|
2
|
Molina J, Peñalva G, Gil-Navarro MV, Praena J, Lepe JA, Pérez-Moreno MA, Ferrándiz C, Aldabó T, Aguilar M, Olbrich P, Jiménez-Mejías ME, Gascón ML, Amaya-Villar R, Neth O, Rodríguez-Hernández MJ, Gutiérrez-Pizarraya A, Garnacho-Montero J, Montero C, Cano J, Palomino J, Valencia R, Álvarez R, Cordero E, Herrero M, Cisneros JM. 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. Clin Infect Dis 2018; 65:1992-1999. [PMID: 29020166 DOI: 10.1093/cid/cix692] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023] Open
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.
Collapse
Affiliation(s)
- José Molina
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | - Germán Peñalva
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | | | | | - José A Lepe
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | | | | | | | - Manuela Aguilar
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | - Peter Olbrich
- Pediatric Infectious Diseases and Immunodeficiency, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville
| | | | | | | | - Olaf Neth
- Pediatric Infectious Diseases and Immunodeficiency, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville
| | | | | | - José Garnacho-Montero
- Department of Critical Care, University Hospital Virgen Macarena, University of Seville
| | - Cristina Montero
- Department of Pediatric Critical Care and Emergency, University Hospital Virgen del Rocio, Seville, Spain
| | - Josefina Cano
- Department of Pediatric Critical Care and Emergency, University Hospital Virgen del Rocio, Seville, Spain
| | - Julián Palomino
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | - Raquel Valencia
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | - Rocío Álvarez
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | - Elisa Cordero
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | - Marta Herrero
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | - José M Cisneros
- Departments of Infectious Diseases, Microbiology and Preventive Medicine
| | | |
Collapse
|