Description of changes in clinical outcomes following the implementation of an antibiotic stewardship program in a level IV hospital
Abstract
Introduction. Inadequate prescription of antibiotics has been recognized as a public health problem by the World Health Organization. In this context, antibiotic stewardship programs have been implemented as a tool to mitigate its impact.
Objective. To describe the changes in clinical outcomes after the implementation of an antibiotic stewardship program in a level IV hospital.
Materials and methods. We conducted a unique cohort study of patients hospitalized for infectious pathologies that were treated with antibiotics in an advanced medical facility. We collected the clinical history before the implementation of the antibiotic stewardship program (2013 to 2015) and then we compared it to the records from 2018 to 2019 collected after the implementation of the program. We evaluated changes in clinical outcomes such as overall mortality, and hospital stay, among others.
Results. We analyzed 1,066 patients: 266 from the preimplementation group and 800 from the post-implementation group. The average age was 59.2 years and 62% of the population was male. Statistically significant differences were found in overall mortality (29% vs 15%; p<0.001), mortality due to infectious causes (25% vs 9%; p<0.001), and average hospital stay (45 days vs 21 days; p<0.001); we also observed a tendency to decrease hospital readmission at 30 days for infectious causes (14% vs 10%; p=0.085).
Conclusions. The antibiotic stewardship program implemented was associated with a decrease in overall mortality and mortality due to infectious causes, as well as in average hospital stay. Our results evidenced the importance of interventions aimed at mitigating the impact of inadequate prescription of antibiotics.
Downloads
References
Organización Mundial de la Salud. La contención de la resistencia a los antimicrobianos. Ginebra, Suiza: OMS; 2005. Fecha de consulta: 16 de agosto de 2019. Disponible en: https://www3.paho.org/hq/index.php?option=com_content&view=article&id=11129:amrantimicrobial-resistance-intro&Itemid=41534&lang=es#gsc.tab=0
European Centre for Disease Prevention and Control. The bacterial challenge: time to react. Technical Report. 2009. Fecha de consulta: 2019/08/16 Disponible en: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time_to_React.pdf
Kaki R, Elligsen M, Walker S, Simor A, Palmay L, Daneman N. Impact of antimicrobial stewardship in critical care: A systematic review. J Antimicrob Chemother. 2011;66:1223-30. https://doi.org/10.1093/jac/dkr137
Patel D, Lawson W, Guglielmo BJ. Antimicrobial stewardship programs: interventions and associated outcomes. Expert Rev Anti Infect Ther. 2008;6:209-22. https://doi.org/10.1586/14787210.6.2.209
Paterson DL. The role of antimicrobial management programs in optimizing antibiotic prescribing within hospitals. Clin Infect Dis. 2006;42(Suppl.2):S90-5. https://doi.org/10.1086/499407
Ohl CA, Luther VP. Antimicrobial stewardship for inpatient facilities. J Hosp Med. 2011;6(Suppl.1):S4-15. https://doi.org/10.1002/jhm.881
Salavert M, Ramírez P, Montero M, Romá E. Implantación de un programa de optimización y uso racional de antimicrobianos en un modelo de área clínica médica. Rev Esp Quimioter. 2018;31:419-26.
Galvis CE, Mariño AC, Monroy J, Posso H. Impact of a policy restricting the use of antibiotics in the neonatal unit of the Central Military Hospital. Med Magazine. 2008;16:19-24
Pallares CJ, Martínez E. Implementation of a regulated antibiotic use program in two medical-surgical intensive units care in a third level mayor teaching hospital in Colombia. Infectio. 2012;16:192-8.
Molano-Franco D, Rojas-Gambasica JA, Beltrán-Garcés CA, NietoEstrada VH, ValenciaMoore AA, Jaller Bornacelli YE, et al. Implementation of a program of rational use of antibiotics in intensive care: ¿can the results be improved? Acta Colombiana de Cuidado Intensivo. 2018;18:71-6.
Pate PG, Storey DF, Baum DL. Implementation of an antimicrobial stewardship program at a 60-bed long-term acute care hospital. Infect Control Hosp Epidemiol. 2012;33:405-8.
Nowak MA, Nelson RE, Breidenbach JL, Thompson PA, Carson PJ. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm. 2012;69:1500-8. https://doi.org/10.2146/ajhp110603
Anderson D, Kaye K. Controlling antimicrobial resistance in the hospital. Infect Dis Clin North Am. 2009;23:847-64. https://doi.org/10.1016/j.idc.2009.06.005
Agents A, Karanika S, Paudel S, Grigoras C, Kalbasi A. Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial. Antimicrob Agents Chemother. 2016;60:4840-52. https://doi.org/10.1128/AAC.00825-16
Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003;24:699-706. https://doi.org/10.1086/502278
Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE, et al. A world wide web–based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces costs in a tertiary care pediatric medical center. Clin Infect Dis. 2008;47:747-53. https://doi.org/10.1086/591133
Bosso JA, Drew RH. Application of antimicrobial stewardship to optimize management of community acquired pneumonia. Int J Clin Pract. 2011;65:775-83. https://doi.org/10.1111/j.1742-1241.2011.02704.x
Rosa RG, Goldani LZ, dos Santos RP. Association between adherence to an antimicrobial stewardship program and mortality among hospitalized cancer patients with febrile neutropaenia: a prospective cohort study. BMC Infect Dis. 2014;14:286. https://doi.org/10.1186/1471-2334-14-286
Some similar items:
- Ricardo Pineda-Tamayo, Giovanna Arcila, Patricia Restrepo, Juan Manuel Anaya, Impact of cardiovascular illness on hospitalization costs in patients with rheumatoid arthritis. , Biomedica: Vol. 24 No. 4 (2004)
- Fernando Rosso, Sara Vanegas, Sarita Rodríguez, Robinson Pacheco, Prevalence and clinical course of dengue infection in elderly patients with acute febrile illness in a tertiary care hospital in Cali, Colombia , Biomedica: Vol. 36 (2016): Suplemento 2, Enfermedades virales
- Andrés Leonardo González, Ruth Aralí Martínez, Luis Ángel Villar, Clinical evolution of dengue in hospitalized patients , Biomedica: Vol. 28 No. 4 (2008)
- Karen Melissa Ordóñez, Odismar Andrea Hernández, Jorge Alberto Cortés, María José López, Gladys Alfonso, Alejandro Junca, Left-sided infective endocarditis caused by Pseudomonas aeruginosa treated medically , Biomedica: Vol. 30 No. 2 (2010)
- Alvaro Vallejos, Adverse reactions by antibiotics in a pediatric and neonatal intensive care unit located in Bogotá, Colombia , Biomedica: Vol. 27 No. 1 (2007)
- Jairo Lizarazo, Melva Linares, Catalina de Bedout, Ángela Restrepo, Clara Inés Agudelo, Elizabeth Castañeda, Grupo Colombiano para el Estudio de la Criptococosis, Results of nine years of the clinical and epidemiological survey on cryptococcosis in Colombia, 1997-2005 , Biomedica: Vol. 27 No. 1 (2007)
- Álvaro J. Ruiz, Pablo J. Aschner, María Fernanda Puerta, Rafael Alfonso-Cristancho, IDEA Study (International Day for the Evaluation of Abdominal Obesity): Primary care study of the prevalence of abdominal obesity and associated risk factors in Colombia , Biomedica: Vol. 32 No. 4 (2012)
- Andrés Leonardo González, Aura Lucía Leal, Jorge Alberto Cortés, Ricardo Sánchez, Liliana Isabel Barrero, Juan Sebastián Castillo, Carlos Arturo Álvarez, Effect of adequate initial antimicrobial therapy on mortality in critical patients with Pseudomonas aeruginosa bacteremia , Biomedica: Vol. 34 (2014): Abril, Suplemento 1, Resistencia bacteriana
- Doris Cardona, Ángela María Segura, Adriana Espinosa, Alejandra Segura, Homicide and suicide in 15 to 24 year-old people in Colombia, 1998-2008 , Biomedica: Vol. 33 No. 4 (2013)
- Myriam Janeth Salazar, Ligia Inés Moncada, Life cycle of Culex quinquefasciatus Say (Diptera: Culicidae) under uncontrolled conditions. , Biomedica: Vol. 24 No. 4 (2004)
Copyright (c) 2023 Biomedica
This work is licensed under a Creative Commons Attribution 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
