RESUMO
BACKGROUND: Antimicrobial resistance rates are increasing. This is, among others, caused by incorrect or inappropriate use of antimicrobials. To target this, a multidisciplinary antimicrobial stewardship-team (A-Team) was implemented at the University Medical Center Groningen on a urology ward. Goal of this study is to evaluate the clinical effects of the case-audits done by this team, looking at length of stay (LOS) and antimicrobial use. METHODS: Automatic e-mail alerts were sent after 48 h of consecutive antimicrobial use triggering the case-audits, consisting of an A-Team member visiting the ward, discussing the patient's therapy with the bed-side physician and together deciding on further treatment based on available diagnostics and guidelines. Clinical effects of the audits were evaluated through an Interrupted Time Series analysis and a retrospective historic cohort. RESULTS: A significant systemic reduction of antimicrobial consumption for all patients on the ward, both with and without case-audits was observed. Furthermore, LOS for patients with case-audits who were admitted primarily due to infections decreased to 6.20 days (95% CI: 5.59-6.81) compared to the historic cohort (7.57 days; 95% CI: 6.92-8.21; p = 0.012). Antimicrobial consumption decreased for these patients from 8.17 DDD/patient (95% CI: 7.10-9.24) to 5.93 DDD/patient (95% CI: 5.02-6.83; p = 0.008). For patients with severe underlying diseases (e.g., cancer) these outcome measures remained unchanged. CONCLUSION: The evaluation showed a considerable positive impact. Antibiotic use of the whole ward was reduced, transcending the intervened patients. Furthermore, LOS and mean antimicrobial consumption for a subgroup was reduced, thereby improving patient care and potentially lowering resistance rates.
RESUMO
In 2012, the Dutch Working Party on Antibiotic Policy (SWAB) published a vision document to counteract the rise in antibiotic use and resistance. An Antibiotic Stewardship Programme (ASP) will be implemented by a multidisciplinary antibiotics team (A-team). In 2012 University Medical Centre Groningen (UMCG) in the Netherlands started an Antibiotic Stewardship Programme (ASP) pilot project at the trauma surgery ward. The focus is on providing bedside consultation for patients based on the day 2 bundle. Implementation of the ASP on the basis of a day 2 bundle resulted in an intervention percentage of 75%. The pilot project was a success and will be extended to other wards.
Assuntos
Antibacterianos/efeitos adversos , Farmacorresistência Bacteriana , Padrões de Prática Médica , Antibacterianos/uso terapêutico , Humanos , Países Baixos , Projetos Piloto , Encaminhamento e ConsultaRESUMO
Like any other drug, antimicrobial drugs are prone to pharmacokinetic drug interactions. These drug interactions are a major concern in clinical practice as they may have an effect on efficacy and toxicity. This article provides an overview of all published pharmacokinetic studies on drug interactions of the commonly prescribed antimicrobial drugs oxazolidinones, rifamycines, macrolides, fluoroquinolones, and beta-lactams, focusing on systematic research. We describe drug-food and drug-drug interaction studies in humans, affecting antimicrobial drugs as well as concomitantly administered drugs. Since knowledge about mechanisms is of paramount importance for adequate management of drug interactions, the most plausible underlying mechanism of the drug interaction is provided when available. This overview can be used in daily practice to support the management of pharmacokinetic drug interactions of antimicrobial drugs.