Impact of Implementing an Antimicrobial Stewardship Program for Optimizing Antibiotic Treatment in Gram-negative Bacilli Bacteremia

García-Cervera Carles; Jover-Díaz Francisco Mariano; Delgado-Sánchez Elisabet; Martin-González Coral; Provencio-Arranz Rosa; Infante-Urrios Ana; Dólera-Moreno Cristina; Esteve-Atiénzar Pedro; Lazcano Teresa Martínez; Peris-García Jorge; Giner-Galvañ Vicente; Ducasse Victoria Ortiz de la Tabla; Sánchez-Miralles Ángel; Aznar-Saliente Teresa

doi:10.3947/ic.2024.0026

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저자정보: García-Cervera Carles (Internal Medicine Service, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.) Jover-Díaz Francisco Mariano (Infectious Diseases Unit, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.Medicine Department, Universitat Miguel Hernandez, Elche, Spain.) Delgado-Sánchez Elisabet (Infectious Diseases Unit, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.) Martin-González Coral (Microbiology Section, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.) Provencio-Arranz Rosa (Pharmacy Service, Hospital Clínico Universitario de San Juan de Alicante, Spain.) Infante-Urrios Ana (Microbiology Section, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.Microbiology Department, Universitat Miguel Hernandez, Elche, Spain.) Dólera-Moreno Cristina (Intensive Care Medicine Service, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.) Esteve-Atiénzar Pedro (Internal Medicine Service, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.) Lazcano Teresa Martínez (Pharmacy Service, Hospital Clínico Universitario de San Juan de Alicante, Spain.) Peris-García Jorge (Infectious Diseases Unit, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.Medicine Department, Universitat Miguel Hernandez, Elche, Spain.) Giner-Galvañ Vicente (Internal Medicine Service, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.Infectious Diseases Unit, Hospital Clínico Universitario de San Juan de Alicante, Alicante,) Ducasse Victoria Ortiz de la Tabla (Microbiology Section, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.Microbiology Department, Universitat Miguel Hernandez, Elche, Spain.) Sánchez-Miralles Ángel (Intensive Care Medicine Service, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.) Aznar-Saliente Teresa (Microbiology Department, Universitat Miguel Hernandez, Elche, Spain.Pharmacology Department, Hospital Clínico Universitario de San Juan de Alicante, Alicante, Spain.)

저널정보: 대한감염학회 Infection and Chemotherapy Infection and Chemotherapy Vol.56 No.3

발행연도: 2024.9

수록면: 351 - 360 (10page)

DOI: 10.3947/ic.2024.0026

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Background Antibiotic Stewardship Programs (ASP) have improved empirical and directed antibiotic treatment in Gram-negative Bacilli (GNB) bloodstream infections. A decrease in mortality, readmission, and length of hospitalization has been reported. Materials and Methods A pre–post-quasi-experimental study was conducted between November and April 2015–2016 (pre-intervention period), 2016–2017, 2017–2018, and 2018–2019 (post-intervention periods), to analyse the impact of ASP on empirical, directed, and entire treatment optimization, as well as mortality, readmission, and length of hospitalization, in hospitalized patients with Gram-negative bacilli (GNB) bloodstream infections. Results One hundred seventy-four patients were included (41 in the pre-intervention group, 38 in the first-year post-intervention group, 50 in the second-year post-intervention group, and 45 in the third-year post-intervention group). There was a significant improvement in directed treatment optimization (43.9% in the pre-intervention group, 68.4% in the first-year post-intervention group, 74% in the second-year post-intervention group, and 88.9% in the third-year post-intervention group, P <0.001), as well as in entire treatment optimization (19.5%, 34.2%, 40.0%, and 46.7%, respectively, P=0.013), with increased optimal directed (adjusted odds ratio [aOR], 3.71; 95% confidence interval [CI], 1.60–8.58) and entire treatment (aOR, 3.31; 95% CI, 1.27–8.58). Although a tendency toward improvement was observed in empirical treatment after ASP implementation, it did not reach statistical significance (41.5% vs. 57.9%, P=0.065). No changes in mortality, readmission, or length of hospitalization were detected. Conclusion ASP implementation improved both directed and entire treatment optimization in patients with GNB bloodstream infections over time. Nevertheless, no improvement was found in clinical outcomes such as mortality, readmission, or length of hospitalization.

Background Antibiotic Stewardship Programs (ASP) have improved empirical and directed antibiotic treatment in Gram-negative Bacilli (GNB) bloodstream infections. A decrease in mortality, readmission, and length of hospitalization has been reported. Materials and Methods A pre–post-quasi-experimental study was conducted between November and April 2015–2016 (pre-intervention period), 2016–2017, 2017–2018, and 2018–2019 (post-intervention periods), to analyse the impact of ASP on empirical, directed, and entire treatment optimization, as well as mortality, readmission, and length of hospitalization, in hospitalized patients with Gram-negative bacilli (GNB) bloodstream infections. Results One hundred seventy-four patients were included (41 in the pre-intervention group, 38 in the first-year post-intervention group, 50 in the second-year post-intervention group, and 45 in the third-year post-intervention group). There was a significant improvement in directed treatment optimization (43.9% in the pre-intervention group, 68.4% in the first-year post-intervention group, 74% in the second-year post-intervention group, and 88.9% in the third-year post-intervention group, P <0.001), as well as in entire treatment optimization (19.5%, 34.2%, 40.0%, and 46.7%, respectively, P=0.013), with increased optimal directed (adjusted odds ratio [aOR], 3.71; 95% confidence interval [CI], 1.60–8.58) and entire treatment (aOR, 3.31; 95% CI, 1.27–8.58). Although a tendency toward improvement was observed in empirical treatment after ASP implementation, it did not reach statistical significance (41.5% vs. 57.9%, P=0.065). No changes in mortality, readmission, or length of hospitalization were detected. Conclusion ASP implementation improved both directed and entire treatment optimization in patients with GNB bloodstream infections over time. Nevertheless, no improvement was found in clinical outcomes such as mortality, readmission, or length of hospitalization.

#Antibiotic stewardship programs #Bloodstream infections #Gram-negative bacilli

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