Summary:
Backround: Even though Antibiotic Stewardship Programs (ASPs) have been proposed as a solution for the global burden of antimicrobial resistance, there is no solid evidence that they are effective in reducing antibiotic resistance in hospital settings. Purpose: The purpose of this study was the retrospective analysis of an ASP with the aim of reducing the consumption of restricted antibiotics and the recorded resistance of Gram-negative bacteria, as well as the evaluation of key factors that may contribute to the expected reduction of antibiotic resistance in order to design a more successful ASP in the future. Methods: The ASP implemented in Hygeia Hospital, which includes both prior approval and post-prescription review and feedback for the monitoring of restricted antibiotics, was analysed for a period of 1 year. Results: The results of the study showed a reduction in the consumption rates of restricted and non – restricted antibiotics (DDDs and DOTs). Adherence to the protocol was 11.0%. The mean duration of therapy was 9.3 days, with no significant differences between empirical and targeted therapy (8.87 VS 9.76, P = 0.060), but significantly shorter duration than that reported in the literature on central venous catheter infection (10.66 days) and hospital acquired pneumonia (10.22 days). The cases in which de – escalation was feasible, but didn’t take place, accounted for 5.5% of the total days of therapy. 30 – day mortality was 20.2%, with no significant difference between empirical and targeted therapy (Empirical 57.7% VS Targeted 42.3%, P = 0.476). C. difficile infection occurred in 4.7%, which was associated with previous use of carbapenems (62.1% VS 37.9%, P = 0.048) and cephalosporins (55.2% VS 44.8%, P = 0.006). New colonization with a multiresistant strain was found in 9.7% of the cases and the days of therapy after colonization accounted for 25.5% of the total days of therapy. Finally, reported allergies accounted for 12.8% of the cases and ammounted to 12.3% of total days of therapy. Conclusions: The evaluation of restricted antibiotics’ consumption and the process and outcome measures demonstrated a functioning ASP. Τhe findings of this study imply that the core elements of a more efficient ASP in the future are the inclusion of: evaluation of the effect of antibiotics on the microbiome, beyond their spectrum of activity, for the reduction of new colonization rates and the methodical investigation of reported allergies for the utilization of first line antibiotics.
Keywords:
antimicrobial agents, antimicrobial resistance, antimicrobial stewardship programs, antimicrobial regimen, interventions