A carbapenem-focused antimicrobial stewardship programme implemented during the COVID-19 pandemic in a setting of high endemicity for multidrug-resistant Gram-negative bacteria.
J Antimicrob Chemother
; 78(4): 1000-1008, 2023 04 03.
Article
em En
| MEDLINE
| ID: mdl-36790896
ABSTRACT
BACKGROUND:
Greece is among the countries characterized by high rates of antimicrobial resistance and high consumption of antibiotics, including carbapenems.OBJECTIVES:
To measure the impact of a carbapenem-focused antimicrobial stewardship programme (ASP) on the antibiotic consumption and patient outcomes in a Greek tertiary hospital during the COVID-19 pandemic.METHODS:
A quasi-experimental, before-after study, comparing a 12 month pre-intervention period with a 12 month intervention period in which a carbapenem-focused ASP was implemented.RESULTS:
A total of 1268 patients were enrolled. The proportion of admitted patients who received carbapenems decreased from 4.1% (842 of 20â629) to 2.3% (426 of 18â245) (-1.8%; Pâ<â0.001). A decrease of -4.9 DDD/100 patient-days (PD) (95% CI -7.3 to -2.6; Pâ=â0.007) in carbapenem use and an increase in the use of piperacillin/tazobactam [+2.1 DDD/100 PD (95% CI 1.0-3.3; Pâ=â0.010)] were observed. Thirty-day mortality following initiation of carbapenem treatment and all-cause in-hospital mortality remained unaltered after ASP implementation. In contrast, length of hospital stay increased (median 17.0 versus 19.0 days; Pâ<â0.001), while the risk of infection-related readmission within 30 days of hospital discharge decreased (24.6% versus 16.8%; Pâ=â0.007). In the post-implementation period, acceptance of the ASP intervention was associated with lower daily hazard of in-hospital death [cause-specific HR (csHR) 0.49; 95% CI 0.30-0.80], lower odds of 30 day mortality (OR 0.36; 95% CI 0.18-0.70) and higher rate of treatment success (csHR 2.45; 95% CI 1.59-3.77).CONCLUSIONS:
Implementing and maintaining a carbapenem-focused ASP is feasible, effective and safe in settings with high rates of antimicrobial resistance, even during the COVID-19 pandemic.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções por Bactérias Gram-Negativas
/
Gestão de Antimicrobianos
/
COVID-19
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article