Riassunto analitico
Background
A major cause of the increase in antimicrobial resistance is the inappro1priate use of antimicrobials. To target this, an antimicrobial stewardship program has been implemented at a department of gastroenterology of the University Hospital of Modena, Italy. Goal of this study was to evaluate the impact of the program on antimicrobial consumption and clinical outcome.
METHODS
Between 1 October 2014 and 30 April 2015 (period A), a specialist in infectious diseases (ID) controlled, twice a week, all antimicrobial prescriptions discussing the therapies with the physicians of the ward and taking a decision together on the therapy to be prescribed. The defined daily doses (DDD) of antimicrobials and antifungals, the mean duration of hospitalization and the mortality rate during the hospitalization were compared with those of the same period of the previous year (1 October 2013 - 30 April 2014, period B).
RESULTS:
During the period A, 206 ID consultations were performed for 118 patients. At the first consultation, the antimicrobial prescription was confirmed in the 58 cases (49.2%), not confirmed in 11 (9.3%), de-escalated in 16 (13.6%), modified in 15 (12.7%), interrupted in 9 (7.6%) and intensified in 9 (7.6%). In comparison with the period B, during the period A antimicrobials consumption decreased from 152.53 to 110.59 DDD per 100 patient-days (DDDx100pd; p=0.117) and antifungals decreased from 53.76 to 33.85 DDDx100pd (p=0.047). The greatest impact of the antimicrobial stewardship was observed on carbapenems that decreased from 20.53 to 6.26 DDDx100pd (p=0.0027), glycopeptides (from 22.58 to 9.31 DDDx100pd, p=0.0253), echinocandins (from 1.90 to 1.03 DDDx100pd, p=0.62) and quinolones (from 38.17 to 21.45 DDDx100pd, p=0.063). No significant differences were observed, during the period A and B, in mortality rate (3.19% and 3.38%, respectively) and in mean length of hospitalization (7.21 and 7.04 days, respectively).
CONCLUSION:
The evaluation showed a considerable positive impact. The consumption of antimicrobials and antifungals decreased considerably and, despite this, the average length of stay and mortality rates did not rise.
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