Impact of a prospective audit and feedback antimicrobial stewardship programme on carbapenem consumption: a quasi-experimental study (IPANEMA study).
J Antimicrob Chemother
; 78(7): 1705-1710, 2023 07 05.
Article
em En
| MEDLINE
| ID: mdl-37248767
ABSTRACT
OBJECTIVES:
To test the hypothesis that a prospective audit and feedback (PAF) intervention combined with electronic tools will reduce carbapenem use without negatively affecting patient outcomes.METHODS:
A quasi-experimental, pre-intervention and intervention study was performed conducted in the urology department of a university hospital. The intervention involved implementing a PAF within an antimicrobial stewardship programme with the aid of an electronic tool. The primary outcome was carbapenem use, assessed by DDD/100 patient-days (PD). Secondary outcomes included evaluating the effect of the intervention on overall antibiotic use measured by DDD/100 PD and days of therapy (DOT)/100 PD, as well as patient safety. The chi-squared test or t-test was used, and the Poisson model was employed to assess the association between the intervention and outcomes.RESULTS:
A 9% decrease in carbapenem DDD/100 PD was observed during the intervention period (IRâ=â0.91; 95% CIâ=â0.85-0.97, Pâ=â0.007). The proportion of patients who received carbapenem treatment dropped from 17.8% to 16.5% [incidence ratio (IR)â=â0.95; 95% CIâ=â0.86-2.05, Pâ=â0.31]. Carbapenem DOT/100 PD decreased from 12.4 to 11.0 (IRâ=â0.89; 95% CIâ=â0.83-0.94, Pâ<â0.001). Overall antibiotic DDD/100 PD decreased by 3% (IRâ=â0.97; 95% CIâ=â0.94-0.99, Pâ=â0.001) and DOT/100 PD by 7% (IRâ=â0.93; 95% CIâ=â0.91-0.95, Pâ<â0.001). The incidence of infections caused by carbapenemase-producing microorganisms, Enterococcus faecium bacteraemia and Clostridioides difficile-associated diarrhoea episodes was similar in the pre-intervention and intervention periods. ESBL incidence rate decreased, but the differences were not statistically significant (3.94/1000 PD versus 2.88/1000 PD, Pâ=â0.111). Length of hospital stay, in-hospital all-cause mortality, and 30 day readmission incidence remained unchanged.CONCLUSIONS:
The implementation of PAF combined with an electronic tool was an effective and safe intervention for reducing carbapenem use.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções Bacterianas
/
Gestão de Antimicrobianos
Tipo de estudo:
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article