Eneritz Velasco-Arnaiz1, Silvia Simó-Nebot2, María Ríos-Barnés1, Maria Goretti López Ramos3, Manuel Monsonís4, Mireia Urrea-Ayala5, Iolanda Jordan6, Anna Mas-Comas3, Ricard Casadevall-Llandrich7, Daniel Ormazábal-Kirchner8, Daniel Cuadras-Pallejà9, Cristina Pérez-Pérez10, Marta Millet-Elizalde10, Emilia Sánchez-Ruiz11, Clàudia Fortuny12, Antoni Noguera-Julian13. 1. Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain. 2. Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain. 3. Pharmacy Department, Sant Joan de Déu Hospital, Barcelona, Spain. 4. Clinical Microbiology Department, Sant Joan de Déu Hospital, Barcelona, Spain. 5. Infection Control Department, Sant Joan de Déu Hospital, Barcelona, Spain. 6. Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain. 7. Management Department, Sant Joan de Déu Hospital, Barcelona, Spain. 8. Computing Department, Sant Joan de Déu Hospital, Barcelona, Spain. 9. Statistics Department, Sant Joan de Déu Research Foundation, Barcelona, Spain. 10. Economy and Finance Department, Sant Joan de Déu Hospital, Barcelona, Spain. 11. Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain. 12. Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain. 13. Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain. Electronic address: ton@sjdhospitalbarcelona.org.
Abstract
OBJECTIVES: To evaluate the results of the first 24 months of a postprescription review with feedback-based antimicrobial stewardship program in a European referral children's hospital. STUDY DESIGN: We performed a pre-post study comparing antimicrobial use between the control (2015-2016) and the intervention periods (2017-2018) expressed in days of therapy/100 days present. Quality of prescriptions was evaluated by quarterly cross-sectional point-prevalence surveys. Length of stay, readmission rates, in-hospital mortality rates, cost of systemic antimicrobial agents, and antimicrobial resistance rates were included as complementary outcomes. RESULTS: Total antimicrobial use and antibacterial use significantly decreased during the intervention period (P = .002 and P = .001 respectively), and total antifungal use remained stable. A significant decline in parenteral antimicrobial use was also observed (P < .001). In 8 quarterly point-prevalence surveys (938 prescriptions evaluated), the mean prevalence of use of any antimicrobial among inpatients was 39%. An increasing trend in the rate of optimal prescriptions was observed after the first point-prevalence survey (P = .0898). Nonoptimal prescriptions were more common in surgical than in medical departments, in antibacterial prescriptions with prophylactic intention, and in empirical more than in targeted treatments. No significant differences were observed in terms of mortality or readmission rates. Only minor changes in antimicrobial resistance rates were noted. CONCLUSIONS: Our antimicrobial stewardship program safely decreased antimicrobial use and expenditure, and a trend toward improvement in quality of prescription was also observed.
OBJECTIVES: To evaluate the results of the first 24 months of a postprescription review with feedback-based antimicrobial stewardship program in a European referral children's hospital. STUDY DESIGN: We performed a pre-post study comparing antimicrobial use between the control (2015-2016) and the intervention periods (2017-2018) expressed in days of therapy/100 days present. Quality of prescriptions was evaluated by quarterly cross-sectional point-prevalence surveys. Length of stay, readmission rates, in-hospital mortality rates, cost of systemic antimicrobial agents, and antimicrobial resistance rates were included as complementary outcomes. RESULTS: Total antimicrobial use and antibacterial use significantly decreased during the intervention period (P = .002 and P = .001 respectively), and total antifungal use remained stable. A significant decline in parenteral antimicrobial use was also observed (P < .001). In 8 quarterly point-prevalence surveys (938 prescriptions evaluated), the mean prevalence of use of any antimicrobial among inpatients was 39%. An increasing trend in the rate of optimal prescriptions was observed after the first point-prevalence survey (P = .0898). Nonoptimal prescriptions were more common in surgical than in medical departments, in antibacterial prescriptions with prophylactic intention, and in empirical more than in targeted treatments. No significant differences were observed in terms of mortality or readmission rates. Only minor changes in antimicrobial resistance rates were noted. CONCLUSIONS: Our antimicrobial stewardship program safely decreased antimicrobial use and expenditure, and a trend toward improvement in quality of prescription was also observed.
Authors: Elena Fresán-Ruiz; Ana Carolina Izurieta-Pacheco; Mònica Girona-Alarcón; Juan Carlos de Carlos-Vicente; Amaya Bustinza-Arriortua; María Slocker-Barrio; Sylvia Belda-Hofheinz; Montserrat Nieto-Moro; Sonia María Uriona-Tuma; Laia Pinós-Tella; Elvira Morteruel-Arizcuren; Cristina Schuffelmann; Yolanda Peña-López; Sara Bobillo-Pérez; Iolanda Jordan Journal: Children (Basel) Date: 2022-06-16
Authors: Elisa Barbieri; Maia De Luca; Marta Minute; Carmen D'Amore; Marta Luisa Ciofi Degli Atti; Stefano Martelossi; Carlo Giaquinto; Liviana Da Dalt; Theoklis Zaoutis; Daniele Dona Journal: Antibiotics (Basel) Date: 2020-12-04