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An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility

Published online by Cambridge University Press:  17 October 2016

Sara Tedeschi*
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Filippo Trapani
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Maddalena Giannella
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Francesco Cristini
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Fabio Tumietto
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Michele Bartoletti
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Annalisa Liverani
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Salvatore Pignanelli
Affiliation:
Laboratory Analysis of Clinical Chemistry and Microbiology, S. Maria della Scaletta Hospital; Imola, Italy
Luisa Toni
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Roberto Pederzini
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Augusto Cavina
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Pierluigi Viale
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
*
Address correspondence to Sara Tedeschi, Infectious Disease Unit, Teaching Hospital S. Orsola-Malpighi, via Massarenti, 11, 40138 Bologna Italy (sara.tedeschi@aosp.bo.it).

Abstract

OBJECTIVE

To assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital.

DESIGN

Quasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation.

SETTING

150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries.

INTERVENTION

Beginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation.

RESULTS

Antibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008).

CONCLUSIONS

An ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital.

Infect Control Hosp Epidemiol. 2016;1–7

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The findings reported in this article were presented as a poster during the 26th European Congress of Clinical Microbiology and Infectious Diseases, April 12, 2016, Amsterdam, Netherlands.

References

REFERENCES

1. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.Google Scholar
2. Wagner, B, Filice, GA, Drekonja, D, et al. Antimicrobial stewardship programs in inpatient hospital settings: a systematic review. Infect Control Hosp Epidemiol 2014;35:12091228.Google Scholar
3. Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.Google Scholar
4. Pope, SD, Dellit, TH, Owens, RC, Hooton, TM, Infectious Diseases Society of A, Society for Healthcare Epidemiology of A. Results of survey on implementation of Infectious Diseases Society of America and Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Infect Control Hosp Epidemiol 2009;30:9798.Google Scholar
5. Giannella, M, Tedeschi, S, Bartoletti, M, Viale, P. Prevention of infections in nursing homes: antibiotic prophylaxis versus infection control and antimicrobial stewardship measures. Expert Rev Anti-infect Ther 2016;14:219230.Google Scholar
6. Schuts, EC, Hulscher, ME, Mouton, JW, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. The Lancet 2016. doi:10.1016/S1473-3099(16)00065-7.Google Scholar
7. Montgomerie, JZ. Infections in patients with spinal cord injuries. Clin Infect Dis 1997;25:12851290; quiz 1291–1282.Google Scholar
8. Evans, CT, LaVela, SL, Weaver, FM, et al. Epidemiology of hospital-acquired infections in veterans with spinal cord injury and disorder. Infect Control Hosp Epidemiol 2008;29:234242.Google Scholar
9. Mylotte, JM, Kahler, L, Graham, R, Young, L, Goodnough, S. Prospective surveillance for antibiotic-resistant organisms in patients with spinal cord injury admitted to an acute rehabilitation unit. Am J Infect Control 2000;28:291297.Google Scholar
10. Mylotte, JM, Graham, R, Kahler, L, Young, L, Goodnough, S. Epidemiology of nosocomial infection and resistant organisms in patients admitted for the first time to an acute rehabilitation unit. Clin Infect Dis 2000;30:425432.Google Scholar
11. Evans, CT, Rogers, TJ, Burns, SP, Lopansri, B, Weaver, FM. Knowledge and use of antimicrobial stewardship resources by spinal cord injury providers. PM & R 2011;3:619623.Google Scholar
12. ATC Index with DDDs. World Health Organization Collaborating Centre for Drug Statistics Methodology website. http://www.whocc.no/atc_ddd_index/. Published 2014. Accessed April 2, 2016.Google Scholar
13. Pignanelli, S, Zaccherini, P, Schiavone, P, Nardi Pantoli, A, Pirazzoli, S, Nannini, R. In vitro antimicrobial activity of several antimicrobial agents against Escherichia coli isolated from community-acquired uncomplicated urinary tract infections. Eur Rev Med Pharmacol Sci 2013;17:206209.Google Scholar
14. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268281.Google Scholar
15. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. 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:e51e77.Google Scholar
16. Fleming, A, Browne, J, Byrne, S. The effect of interventions to reduce potentially inappropriate antibiotic prescribing in long-term care facilities: a systematic review of randomised controlled trials. Drugs Aging 2013;30:401408.Google Scholar
17. Jump, RL, Olds, DM, Seifi, N, et al. Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use. Infect Control Hosp Epidemiol 2012;33:11851192.Google Scholar
18. Evans, CT, Rogers, TJ, Weaver, FM, Burns, SP. Providers’ beliefs and behaviors regarding antibiotic prescribing and antibiotic resistance in persons with spinal cord injury or disorder. J Spinal Cord Med 2011;34:1621.Google Scholar
19. Luzzaro, F, Mezzatesta, M, Mugnaioli, C, et al. Trends in production of extended-spectrum beta-lactamases among enterobacteria of medical interest: report of the second Italian nationwide survey. J Clin Microbiol 2006;44:16591664.Google Scholar
20. Mylotte, JM, Graham, R, Kahler, L, Young, BL, Goodnough, S. Impact of nosocomial infection on length of stay and functional improvement among patients admitted to an acute rehabilitation unit. Infect Control Hosp Epidemiol 2001;22:8387.Google Scholar