Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome

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• 作者：Andrea Bedini^a ; ^{andreabedini@yahoo.com" class="auth_mail" title="E-mail the corresponding author} ; Nicola De Maria^b ; Mariagrazia Del Buono^b ; Marcello Bianchini^b ; Mauro Mancini^c ; Cecilia Binda^b ; Andrea Brasacchio^a ; Gabriella Orlando^a ; Erica Franceschini^a ; Marianna Meschiari^a ; Alessandro Sartini^b ; Stefano Zona^a ; Serena Paioli^c ; Erica Villa^b ; Inge C. Gyssens^d ; Cristina Mussini^a
• 关键词：Antifungals ; Antimicrobial stewardship ; Carbapenems ; Gastroenterology ; MDR-microorganisms
• 刊名：Digestive and Liver Disease
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：48
• 期：10
• 页码：1142-1147
• 全文大小：624 K

文摘

A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials.

Aims

To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department.

Methods

Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A).

Results

During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p = 0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p = 0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p = 0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p = 0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate.

Conclusions

ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality.