Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU
Information on the long-term effects of non-restrictive antimicrobial stewardship (AMS) strategies is scarce. We assessed the effect of a stepwise, multimodal, non-restrictive AMS programme on broad-spectrum antibiotic use in the intensive care unit (ICU) over an 8-year period. Components of the AMS...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/13/2/132 |
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| author | Mar Ronda Victor Daniel Gumucio-Sanguino Evelyn Shaw Rosa Granada Fe Tubau Eva Santafosta Joan Sabater Francisco Esteve Cristian Tebé Rafael Mañez Jordi Carratalà Mireia Puig-Asensio Sara Cobo-Sacristán Ariadna Padullés |
| author_facet | Mar Ronda Victor Daniel Gumucio-Sanguino Evelyn Shaw Rosa Granada Fe Tubau Eva Santafosta Joan Sabater Francisco Esteve Cristian Tebé Rafael Mañez Jordi Carratalà Mireia Puig-Asensio Sara Cobo-Sacristán Ariadna Padullés |
| author_sort | Mar Ronda |
| collection | DOAJ |
| description | Information on the long-term effects of non-restrictive antimicrobial stewardship (AMS) strategies is scarce. We assessed the effect of a stepwise, multimodal, non-restrictive AMS programme on broad-spectrum antibiotic use in the intensive care unit (ICU) over an 8-year period. Components of the AMS were progressively implemented. Appropriateness of antibiotic prescribing was also assessed by monthly point-prevalence surveys from 2013 onwards. A Poisson regression model was fitted to evaluate trends in the reduction of antibiotic use and in the appropriateness of their prescription. From 2011 to 2019, a total of 12,466 patients were admitted to the ICU. Antibiotic use fell from 185.4 to 141.9 DDD per 100 PD [absolute difference, −43.5 (23%), 95% CI −100.73 to 13.73; <i>p</i> = 0.13] and broad-spectrum antibiotic fell from 41.2 to 36.5 [absolute difference, −4.7 (11%), 95% CI −19.58 to 10.18; <i>p</i> = 0.5]. Appropriateness of antibiotic prescribing rose by 11% per year [IRR: 0.89, 95% CI 0.80 to 1.00; <i>p</i> = 0.048], while broad-spectrum antibiotic use showed a dual trend, rising by 22% until 2015 and then falling by 10% per year since 2016 [IRR: 0.90, 95% CI 0.81 to 0.99; <i>p</i> = 0.03]. This stepwise, multimodal, non-restrictive AMS achieved a sustained reduction in broad-spectrum antibiotic use in the ICU and significantly improved appropriateness of antibiotic prescribing. |
| first_indexed | 2024-03-07T22:45:03Z |
| format | Article |
| id | doaj.art-f15b163305a44bc3a345884037eb79fa |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-07T22:45:03Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-f15b163305a44bc3a345884037eb79fa2024-02-23T15:05:01ZengMDPI AGAntibiotics2079-63822024-01-0113213210.3390/antibiotics13020132Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICUMar Ronda0Victor Daniel Gumucio-Sanguino1Evelyn Shaw2Rosa Granada3Fe Tubau4Eva Santafosta5Joan Sabater6Francisco Esteve7Cristian Tebé8Rafael Mañez9Jordi Carratalà10Mireia Puig-Asensio11Sara Cobo-Sacristán12Ariadna Padullés13Department of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Intensive Care, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Intensive Care, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Microbiology, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Intensive Care, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Intensive Care, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Intensive Care, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainBiostatistics Support and Research Unit, Germans Trias i Pujol Research Institute and Hospital (IGTP), Carretera de Can Ruti, Camí de les Escoles s/n, 08916 Badalona, Barcelona, SpainDepartment of Intensive Care, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Infectious Diseases, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainDepartment of Pharmacy, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, SpainCentro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Av. Monforte de Lemos, 3-5, 28029 Madrid, SpainInformation on the long-term effects of non-restrictive antimicrobial stewardship (AMS) strategies is scarce. We assessed the effect of a stepwise, multimodal, non-restrictive AMS programme on broad-spectrum antibiotic use in the intensive care unit (ICU) over an 8-year period. Components of the AMS were progressively implemented. Appropriateness of antibiotic prescribing was also assessed by monthly point-prevalence surveys from 2013 onwards. A Poisson regression model was fitted to evaluate trends in the reduction of antibiotic use and in the appropriateness of their prescription. From 2011 to 2019, a total of 12,466 patients were admitted to the ICU. Antibiotic use fell from 185.4 to 141.9 DDD per 100 PD [absolute difference, −43.5 (23%), 95% CI −100.73 to 13.73; <i>p</i> = 0.13] and broad-spectrum antibiotic fell from 41.2 to 36.5 [absolute difference, −4.7 (11%), 95% CI −19.58 to 10.18; <i>p</i> = 0.5]. Appropriateness of antibiotic prescribing rose by 11% per year [IRR: 0.89, 95% CI 0.80 to 1.00; <i>p</i> = 0.048], while broad-spectrum antibiotic use showed a dual trend, rising by 22% until 2015 and then falling by 10% per year since 2016 [IRR: 0.90, 95% CI 0.81 to 0.99; <i>p</i> = 0.03]. This stepwise, multimodal, non-restrictive AMS achieved a sustained reduction in broad-spectrum antibiotic use in the ICU and significantly improved appropriateness of antibiotic prescribing.https://www.mdpi.com/2079-6382/13/2/132antimicrobial stewardshipinterrupted time series analysisICUbroad-spectrum antibioticsappropriateness of antibiotic prescribing |
| spellingShingle | Mar Ronda Victor Daniel Gumucio-Sanguino Evelyn Shaw Rosa Granada Fe Tubau Eva Santafosta Joan Sabater Francisco Esteve Cristian Tebé Rafael Mañez Jordi Carratalà Mireia Puig-Asensio Sara Cobo-Sacristán Ariadna Padullés Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU Antibiotics antimicrobial stewardship interrupted time series analysis ICU broad-spectrum antibiotics appropriateness of antibiotic prescribing |
| title | Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU |
| title_full | Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU |
| title_fullStr | Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU |
| title_full_unstemmed | Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU |
| title_short | Long-Term Effects of a Stepwise, Multimodal, Non-Restrictive Antimicrobial Stewardship Programme for Reducing Broad-Spectrum Antibiotic Use in the ICU |
| title_sort | long term effects of a stepwise multimodal non restrictive antimicrobial stewardship programme for reducing broad spectrum antibiotic use in the icu |
| topic | antimicrobial stewardship interrupted time series analysis ICU broad-spectrum antibiotics appropriateness of antibiotic prescribing |
| url | https://www.mdpi.com/2079-6382/13/2/132 |
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