Long-term carbapenems antimicrobial stewardship program
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Identificadores
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Fecha de publicación
2020-12-26Título de revista
Antibiotics
Tipo de contenido
Artigo
DeCS
sepsis | infección hospitalaria | carbapenems | incidencia | farmacorresistencia microbiana | candidemia | bacteriemiaMeSH
Carbapenems | Candidemia | Bacteremia | Drug Resistance, Microbial | Cross Infection | Sepsis | IncidenceResumen
Abstract: Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship
programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December
2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out
between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to
local guidelines and compare results between cases with accepted or rejected intervention. Analysis
of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections
(BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription
improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were
performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was
accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all
antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period
2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI:
0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02),
and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17;
95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could
have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR
BSIs, and candidemia, despite the increase in other antibiotic-consumption.
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