Lucía García-San Miguel1, Javier Cobo2, José Antonio Martínez3, Josep Maria Arnau4, Javier Murillas5, Carmen Peña6, Ferran Segura7, Montserrat Gurguí8, Juan Gálvez9, Montserrat Giménez10, Francesc Gudiol6. 1. Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España. Electronic address: lgsanmiguel@salud.madrid.org. 2. Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España. 3. Servicio de Medicina Interna, Hospital Clínic, Barcelona, España. 4. Servicio de Farmacología Clínica, Hospital Vall d'Hebron, Barcelona, España. 5. Servicio de Medicina Interna, Hospital Son Espases, Palma de Mallorca, España. 6. Servicio de Enfermedades Infecciosas, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España. 7. Servicio de Medicina Interna, Hospital Parc Taulí, Sabadell, Barcelona, España. 8. Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 9. Servicio de Enfermedades Infecciosas, Hospital Virgen Macarena, Sevilla, España. 10. Servicio de Microbiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
Abstract
INTRODUCTION: Stewardship programs on the use of antibiotics usually include interventions based on non-compulsory recommendations for the prescribers. Factors related to the adherence to expert recommendations, and the implementation of these programmes in daily practice, are of interest. METHODS: A randomized, controlled, multicentre intervention study was performed in 32 hospitalization units. Antibiotic prescriptions were evaluated by an infectious disease specialist on the third day. We describe the implementation of the intervention, the factors associated with adherence to recommendations, and the impact of the intervention. RESULTS: A total of 3,192 interventions were carried out. Information sources used to prepare the recommendations varied significantly between centres. A modification was recommended in 65% of cases: withdrawal (47%), change in administration route (26%), change of drugs or number of antibiotics (27%), and change in dose (5%). Simplification of treatment accounted for 75% of all recommendations. Adherence was 68%, with significant differences between hospitals, and higher when the recommendations consisted of a dose adjustment or change of route, during the first intervention period, and also when recommendations were personally commented on, in addition to writing a note in the clinical chart. We did not find any reduction in antibiotic consumption or variation in the incidence of resistant pathogens. CONCLUSIONS: An important proportion of antibiotic prescriptions may be susceptible to improvement, most of them towards simplification. The adherence to the intervention was high, but significant variations at different centres were observed, depending on the type of recommendation, and the study period. Those recommendations that were personally commented on were more followed more than those only written.
RCT Entities:
INTRODUCTION: Stewardship programs on the use of antibiotics usually include interventions based on non-compulsory recommendations for the prescribers. Factors related to the adherence to expert recommendations, and the implementation of these programmes in daily practice, are of interest. METHODS: A randomized, controlled, multicentre intervention study was performed in 32 hospitalization units. Antibiotic prescriptions were evaluated by an infectious disease specialist on the third day. We describe the implementation of the intervention, the factors associated with adherence to recommendations, and the impact of the intervention. RESULTS: A total of 3,192 interventions were carried out. Information sources used to prepare the recommendations varied significantly between centres. A modification was recommended in 65% of cases: withdrawal (47%), change in administration route (26%), change of drugs or number of antibiotics (27%), and change in dose (5%). Simplification of treatment accounted for 75% of all recommendations. Adherence was 68%, with significant differences between hospitals, and higher when the recommendations consisted of a dose adjustment or change of route, during the first intervention period, and also when recommendations were personally commented on, in addition to writing a note in the clinical chart. We did not find any reduction in antibiotic consumption or variation in the incidence of resistant pathogens. CONCLUSIONS: An important proportion of antibiotic prescriptions may be susceptible to improvement, most of them towards simplification. The adherence to the intervention was high, but significant variations at different centres were observed, depending on the type of recommendation, and the study period. Those recommendations that were personally commented on were more followed more than those only written.
Keywords:
Antibiotic policy; Antibiotic use control; Control de antibióticos; PROA; Política de antibióticos; Rational use of antibiotics; Stewardship program; Uso prudente de antimicrobianos
Authors: Peter Davey; Charis A Marwick; Claire L Scott; Esmita Charani; Kirsty McNeil; Erwin Brown; Ian M Gould; Craig R Ramsay; Susan Michie Journal: Cochrane Database Syst Rev Date: 2017-02-09