RESUMEN
Primary care antimicrobial stewardship program (ASP) interventions can reduce the over-prescription of unnecessary antibiotics, but the impact on the reduction in bacterial resistance is less known, and there is a lack of available data. We implemented a prolonged educational counseling ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, which was compared to a pre-intervention period, a significant reduction in antibiotic prescriptions occurred, particularly those associated with greater harmful effects and resistance selection. There was also a decrease in methicillin-resistant Staphylococcus aureus (MRSA) strains and in their co-resistance to other antibiotics, particularly those with an ecological impact.
RESUMEN
Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription.
Asunto(s)
Artritis Infecciosa/microbiología , Traumatismos de la Rodilla/microbiología , Articulación de la Rodilla/microbiología , Micosis/microbiología , Osteomielitis/microbiología , Scedosporium/aislamiento & purificación , Infección de Heridas/microbiología , Adolescente , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/etiología , Artritis Infecciosa/cirugía , Terapia Combinada , Desbridamiento , Enterobacter cloacae/aislamiento & purificación , Infecciones por Enterobacteriaceae/complicaciones , Infecciones por Enterobacteriaceae/microbiología , Humanos , Inmunocompetencia , Masculino , Micosis/tratamiento farmacológico , Micosis/cirugía , Osteomielitis/tratamiento farmacológico , Osteomielitis/etiología , Osteomielitis/cirugía , Líquido Sinovial/microbiología , Heridas Penetrantes/microbiologíaRESUMEN
BACKGROUND AND OBJECTIVE: To identify the infection risk factors in knee and hip total prosthesis. METHOD: Case-control study of arthoplasties performed during 10 years. RESULTS: By means of conditional multivariate analysis, infection risk factors with greater odds ratio (OR) were surgical risk rate >or= 2, according to the National Nosocomial Infections Surveillance (NNIS) (OR, 3.3; 95% confidence interval [CI], 1.1-10.8) and post-operative non-infectious complications (OR, 8.9; 95% CI, 1.1-83.1) (p < 0.05). The global infection rate was 2.4% (95% CI, 1.6%-3.2%) of 1,666 joint implants. Gram-positive cocci were the principal involved microorganisms (63%). CONCLUSIONS: A high NNIS together with non-infectious post-operative complications increase the risk of prosthesis infection.
