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Title: 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.
Authors: Molina, José
Peñalva, Germán
Gil-Navarro, María V
Praena, Julia
Lepe, José A
Pérez-Moreno, María A
Ferrándiz, Carmen
Aldabó, Teresa
Aguilar, Manuela
Olbrich, Peter
Jiménez-Mejías, Manuel E
Gascón, María L
Amaya-Villar, Rosario
Neth, Olaf
Rodríguez-Hernández, María J
Gutiérrez-Pizarraya, Antonio
Garnacho-Montero, José
Montero, Cristina
Cano, Josefina
Palomino, Julián
Valencia, Raquel
Álvarez, Rocío
Cordero, Elisa
Herrero, Marta
Cisneros, José M
Keywords: Antimicrobial stewardship programs;antimicrobial resistance;educational interviews;hospital-acquired infections;multidrug-resistant bloodstream infections
metadata.dc.subject.mesh: Anti-Bacterial Agents
Antimicrobial Stewardship
Cross Infection
Drug Prescriptions
Drug Resistance, Multiple, Bacterial
Drug Utilization
Interrupted Time Series Analysis
Physician's Role
Practice Patterns, Physicians'
Tertiary Care Centers
Issue Date: 2017
Abstract: 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. 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). 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). 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.
metadata.dc.identifier.doi: 10.1093/cid/cix692
Appears in Collections:Producción 2020

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