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. 2022 Dec 8;11(12):1776.
doi: 10.3390/antibiotics11121776.

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections

Alfredo Jover-Sáenz  1 , María Ramírez-Hidalgo  1 , Alba Bellés Bellés  2 , Esther Ribes Murillo  3 , Meritxell Batlle Bosch  4 , José Cayado Cabanillas  5 , Sònia Garrido-Calvo  6 , María Isabel Gracia Vilas  7 , Laura Gros Navés  8 , María Jesús Javierre Caudevilla  9 , Alba Mari López  5 , Lidia Montull Navarro  10 , Mireia Ortiz Valls  6 , Gemma Terrer Manrique  6 , Pilar Vaqué Castilla  11 , José Javier Ichart Tomás  12 , Elena Justribó Sánchez  13 , Ester Andreu Mayor  14 , Joan Carrera Guiu  15 , Roser Martorell Solé  16 , Silvia Pallàs Satué  17 , Mireia Saura Codina  12 , Ana Vena Martínez  18 , José Manuel Albalat Samper  19 , Susana Cano Marrón  20 , Isabel Chacón Domínguez  21 , David de la Rica Escuin  22 , María José Estadella Servalls  23 , Ana M Figueres Farreny  24 , Sonia Minguet Vidal  25 , Luís Miguel Montaña Esteban  26 , Josep Otal Bareche  27 , Mercè Pallerola Planes  28 , Francesc Pujol Aymerich  29 , Andrés Rodríguez Garrocho  30 , Antoni Solé Curcó  16 , Francisca Toribio Redondo  31 , María Cruz Urgelés Castillón  32 , Juan Valgañon Palacios  33 , Joan Torres-Puig-Gros  34 , The P-Ilehrda Group, On Behalf Of Translational Research Group On Infectious Diseases Of Lleida Head Group Tridle-IRBLleida
Affiliations

Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections

Alfredo Jover-Sáenz et al. Antibiotics (Basel). .

Abstract

Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription.

Keywords: antimicrobial stewardship; community onset; epidemiology; multidrug-resistant microorganisms; use antimicrobials.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Organizational flow chart.
Figure 2
Figure 2
Semestral evolution of defined daily doses per 1000 inhabitants/day (DID). Global antimicrobial prescription (upper line) and non-recommended antimicrobials (NRA) (lower line). Shaded area represents the pre-antibiotic stewardship program (ASP) intervention period.
Figure 3
Figure 3
Semestral evolution of defined daily doses per 1000 inhabitants/day (DID). (a) Quinolones, (b) cephalosporins, (c) co-amoxiclav, (d) recommended antimicrobials: fosfomycin trometamol, nitrofurantoin.
Figure 4
Figure 4
Semestral evolution of antibiotic-resistant E. coli and K. pneumoniae in urine cultures per incidence density (ID) per 1000 inhabitants/day. (a) Ciprofloxacin resistance, (b) co-amoxiclav resistance, (c) extended-spectrum B-lactamase (ESBL).
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