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. 2022 Mar 10;11(3):372.
doi: 10.3390/antibiotics11030372.

Clinical and Microbiological Effects of an Antimicrobial Stewardship Program in Urology-A Single Center Before-After Study

Oana Joean  1 , Daniel Tahedl  2 , Madita Flintrop  2 , Thorben Winkler  2 , Ruxandra Sabau  3 , Tobias Welte  1   4 , Markus A Kuczyk  2 , Ralf-Peter Vonberg  5 , Jessica Rademacher  1   4
Affiliations

Clinical and Microbiological Effects of an Antimicrobial Stewardship Program in Urology-A Single Center Before-After Study

Oana Joean et al. Antibiotics (Basel). .

Abstract

Antimicrobial resistance is a major public health issue caused by antibiotic overuse and misuse. Antimicrobial stewardship (AMS) has been increasingly endorsed worldwide, but its effect has been studied scarcely in urologic settings. A before-after study was performed from 2018 through 2020 to evaluate changes in antimicrobial prescription, resistance rates and clinical safety upon implementation of an AMS audit and feedback program in the Urology Department of a large German academic medical center. The primary endpoints were safety clinical outcomes: the rate of infection-related readmissions and of infectious complications after transrectal prostate biopsies. Resistance rates and antimicrobial consumption rates were the secondary endpoints. The AMS team reviewed 196 cases (12% of all admitted in the department). The overall antibiotic use dropped by 18.7%. Quinolone prescriptions sank by 78.8% (p = 0.02) and 69.8% (p > 0.05) for ciprofloxacin and levofloxacin, respectively. The resistance rate of E. coli isolates declined against ceftriaxone (−9%), ceftazidime (−12%) and quinolones (−25%) in the AMS period. No significant increase in infection-related readmissions or infectious complications after prostate biopsies was observed (p = 0.42). Due to the potential to reduce antibiotic use and resistance rates with no surge of infection-related complications, AMS programs should be widely implemented in urologic departments.

Keywords: antibiotics; antimicrobial resistance; antimicrobial stewardship; quinolone; urology.

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Conflict of interest statement

O.J., D.T., M.F., Th.W., R.S., M.A.K. and R.P.V. declare that they have no conflict of interest in relation to this study. T.W. received grants and/or advisory/lecture/clinical trial fees from DFG (German Research Council), BMBF (German Ministry of Research and Education), BMG (German Ministry of Health), EU, WHO (research grants), AstraZeneca, Basilea, Biotest, Bayer, Boehringer, Berlin Chemie, GSK, Infectopharm, MSD, Novartis, Pfizer, Roche (fees for lectures), AstraZeneca, Basilea, Biotest, Bayer, Boehringer, Gilead, GSK, Janssens, Novartis, Pfizer, Roche (advisory boards) outside the submitted work. J.R. received grants and/or advisory/lecture/clinical trial fees and/or non-financial support from AstraZeneca, Bayer, Chiesi, Esanum, GlaxoSmithKline, Grifols, MedUpdate Novartis and Shinogi outside the submitted work. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Antimicrobial stewardship interventions. AMS: antimicrobial stewardship.
Figure 2
Figure 2
Changes in antimicrobial prescription patterns during the antimicrobial stewardship program; green bars: pre-antimicrobial stewardship; yellow bars: antimicrobial stewardship; * p < 0.05, AMS: antimicrobial stewardship.
Figure 3
Figure 3
The dynamics of the antimicrobial resistance patterns for E. faecalis, E. faecium, E. coli, K. pneumoniae, P. mirabilis and P. aeruginosa upon implementation of an antimicrobial stewardship program in the urology department. A/S: Ampicillin/Sulbactam; P/T: Piperacilin/Tazobactam; CRO: Ceftriaxone; CAZ: Ceftazidime; LEV: Levofloxacine; CIP: Ciprofloxacine; MER: Meropenem; VAN: Vancomycin.
Figure 4
Figure 4
The antimicrobial stewardship intervention in the urology department.
See this image and copyright information in PMC

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