Background The treatment of infections caused by multiresistant gram-negative bacteria is a growing challenge in many hospitals. To combat this problem, the development of antimicrobial stewardship programmes (ASP), consisting of specialists in antimicrobial use from different units coordinated by infectious diseases specialists, is recommended.
Purpose The aim was to assess the impact of ASP on carbapenems resistance and consumption in a tertiary university hospital.
Material and methods A quasi-experimental study was designed before (March 2013–February 2014) and during the intervention (March 2014–February 2016). Patients prescribed carbepenems (meropenem, imipenem) were identified daily through the prescription drugs computer system (Farmatools). We recorded the impact of the programme on carbapenems consumption, in terms of defined daily dose (DDD)/1000 hospital stays, and the impact on the development of strains of Pseudomonas aeruginosa, Klebsiella pneumoniae, other Enterobacteria and Acinetobacter baumannii resistant to carbapenems using the percentage of resistance (number of resistant isolates/total of isolates x100). The results were presented using the mean and standard deviation (SD) for quantitative data (P-values were determined using Student’s t-test) and as percentages for qualitative variables (P-values were determined using the Chi-square test). Statistical tests were carried out at the 5% significance level. Data was performed in SPSS. The DDD/1000 patient days were calculated following the methodology of the Anatomical Therapeutic Chemical (ATC)/DDD system 2014.
Results The results show a significant reduction in the consumption of meropenem (90.53 (SD: 26.12) vs 24.96 (SD: 8.80), p<0.001) and imipenem (6.55 (SD: 2.75) vs 2.34 (SD: 1.34); p<0.001) in the intervention period. It is important to note that the carbapenem used in most cases is meropenem, being less frequent than the prescription of imipenem in our field of study. It has also been shown in this period a significant decrease in the resistance of three of the four microorganisms studied: Klebsiella pneumoniae (46% vs 38%, p=0.009), Acinetobacter baumannii (63% vs 32%, p<0.001) and Enterobacteriaceae (18% vs 13%, p<0.001), especially accentuated in the case of Acinetobacter. Not so in the case of Pseudomonas aeruginosa (17% vs 15%, p=0.422).
Conclusion The antimicrobial stewardship programme, aimed at optimising the prescription of antimicrobial drugs, has proven to be an effective and durable tool in combating increasing bacterial resistance and, at the same time, it has helped reduce the consumption of antimicrobials.
References and/or acknowledgements 1. del Arco A,Tortajada B, et al. The impact of an antimicrobial stewardship programme in the use of antimicrobials and the evolution of drug resistance. Eur J Clin Microbiol Infect Dis2015;34:247–51.
No conflict of interest.
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