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. 2024 Sep;56(3):351-360.
doi: 10.3947/ic.2024.0026. Epub 2024 Jul 4.

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

Carles García-Cervera  1 , Francisco Mariano Jover-Díaz  2   3 , Elisabet Delgado-Sánchez  2 , Coral Martin-González  4 , Rosa Provencio-Arranz  5 , Ana Infante-Urrios  4   6 , Cristina Dólera-Moreno  7 , Pedro Esteve-Atiénzar  1 , Teresa Martínez Lazcano  5 , Jorge Peris-García  2   8 , Vicente Giner-Galvañ  1   2 , Victoria Ortiz de la Tabla Ducasse  4   6 , Ángel Sánchez-Miralles  7 , Teresa Aznar-Saliente  5   9
Affiliations

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

Carles García-Cervera et al. Infect Chemother. 2024 Sep.

Abstract

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.

Keywords: Antibiotic stewardship programs; Bloodstream infections; Gram-negative bacilli.

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Conflict of interest statement

No conflict of interest.

Figures

Figure 1
Figure 1. Flow chart for patient selection and inclusion and exclusion criteria.
Figure 2
Figure 2. Degree of treatment optimization distributed by periods.
See this image and copyright information in PMC

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References

    1. Rodríguez-Baño J, Paño-Pardo JR, Alvarez-Rocha L, Asensio Á, Calbo E, Cercenado E, Cisneros JM, Cobo J, Delgado O, Garnacho-Montero J, Grau S, Horcajada JP, Hornero A, Murillas-Angoiti J, Oliver A, Padilla B, Pasquau J, Pujol M, Ruiz-Garbajosa P, San Juan R, Sierra R. GEIH-SEIMC; SEFH; SEMPSPH. Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH. Farm Hosp. 2012;3633:e1–30. [Programs for optimizing the use of antibiotics (PROA) in Spanish hospitals: GEIH-SEIMC, SEFH and SEMPSPH consensus document] - PubMed
    1. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51–e77. - PMC - PubMed
    1. Niwa T, Watanabe T, Goto T, Ohta H, Nakayama A, Suzuki K, Shinoda Y, Tsuchiya M, Yasuda K, Murakami N, Itoh Y. Daily review of antimicrobial use facilitates the early optimization of antimicrobial therapy and improves clinical outcomes of patients with bloodstream infections. Biol Pharm Bull. 2016;39:721–727. - PubMed
    1. Bias TE, Vincent WR, 3rd, Trustman N, Berkowitz LB, Venugopalan V. Impact of an antimicrobial stewardship initiative on time to administration of empirical antibiotic therapy in hospitalized patients with bacteremia. Am J Health Syst Pharm. 2017;74:511–519. - PubMed
    1. Merino E, Caro E, Ramos JR, Boix V, Gimeno A, Rodríguez JC, Riera G, Más P, Sanchéz-Paya J, Reus S, Torrús D, Portilla J. Impact of a stewardship program on bacteraemia in adult inpatients. Rev Esp Quimioter. 2017;30:257–263. - PubMed