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An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility

Published online by Cambridge University Press:  17 October 2016

Sara Tedeschi ,
Filippo Trapani ,
Maddalena Giannella ,
Francesco Cristini ,
Fabio Tumietto ,
Michele Bartoletti ,
Annalisa Liverani ,
Salvatore Pignanelli ,
Luisa Toni  and
Roberto Pederzini
...Show all authors
Sara Tedeschi*
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Filippo Trapani
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Maddalena Giannella
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Francesco Cristini
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Fabio Tumietto
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Michele Bartoletti
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
Annalisa Liverani
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Salvatore Pignanelli
Affiliation:
Laboratory Analysis of Clinical Chemistry and Microbiology, S. Maria della Scaletta Hospital; Imola, Italy
Luisa Toni
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Roberto Pederzini
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Augusto Cavina
Affiliation:
Montecatone Rehabilitation Institute; Imola, Italy
Pierluigi Viale
Affiliation:
Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna; Bologna, Italy
*
Address correspondence to Sara Tedeschi, Infectious Disease Unit, Teaching Hospital S. Orsola-Malpighi, via Massarenti, 11, 40138 Bologna Italy (sara.tedeschi@aosp.bo.it).
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Abstract

OBJECTIVE

To assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital.

DESIGN

Quasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation.

SETTING

150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries.

INTERVENTION

Beginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation.

RESULTS

Antibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008).

CONCLUSIONS

An ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital.

Infect Control Hosp Epidemiol. 2016;1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 76 - 82
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The findings reported in this article were presented as a poster during the 26th European Congress of Clinical Microbiology and Infectious Diseases, April 12, 2016, Amsterdam, Netherlands.

References

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