A joint program of antimicrobial stewardship and hospital-acquired infection control to reduce healthcare-associated infections after kidney transplantation: The Hipomenes study.

ABSTRACT

Infection is a common complication in kidney transplant recipients (KTRs). The usefulness of antimicrobial stewardship programs (ASP) and hospital-acquired infection control (HAIC) initiatives in the general inpatient population is well established. We performed a quasi-experimental study to evaluate a joint ASP/HAIC initiative focused on KTRs. A dedicated ASP team optimized antimicrobial prescriptions in consecutive KTRs during the intervention period (June 2015-March 2016). A multifaceted, evidence-based HAIC program was concurrently implemented. Results were compared with the preceding period (June 2014-March 2015). We included 96 and 100 KTRs in the intervention and preintervention periods, respectively. There was a reduction in the consumption of meropenem (rate ratio [RR] 0.63; 95% confidence interval [CI] 0.53-0.75; P <.0001), ceftazidime (RR 0.31; 95% CI 0.21-0.45; P <.0001), vancomycin (RR 0.65; 95% CI 0.53-0.8; P <.0001), and ciprofloxacin (RR 0.66; 95% CI 0.55-0.81; P <.0001) and an increase of fosfomycin (RR 1.80; 95% CI 1.17-2.76; P =.008) during the intervention period. The incidence of cystitis (RR 0.30; 95% CI 0.28-0.33; P <.001) and upper urinary tract infection (RR 0.56; 95% CI 0.33-0.95; P =.04) decreased. A specific ASP/HAIC initiative was effective in optimizing antimicrobial use and reducing the incidence of common bacterial infections among KTRs.