Stewardship / Resistance Scan for Nov 23, 2020

Antibiotic stewardship for pneumonia
Jordanian hospital ASP

Danish stewardship intervention tied to improved pneumonia prescribing

An antibiotic stewardship intervention implemented at four regional hospitals in Denmark was associated with significantly lower overall antibiotic exposure for patients who had community acquired pneumonia (CAP) and a higher likelihood of patients being treated with recommended antibiotics, Danish researchers reported late last week in the International Journal of Infectious Diseases.

The intervention, implemented at the hospitals to increase adherence to prescribing guidelines and improve the quality of care for CAP patients, included physician education, feedback to physicians regarding antibiotic choice, pocket cards on CAP treatment, and order sets for CAP in the electronic health system. The study assessed antibiotic prescribing in CAP patients treated at the four hospitals during the baseline period (November 2017 through February 2018) and the follow-up period after implementation of the stewardship program (November 2018 through February 2019).

The primary outcome of the study was the proportion of patients receiving 7 days or less of antibiotics, and the secondary outcomes were the proportion receiving 3 days or less of intravenous (IV) antibiotics and the proportion receiving empiric antibiotics according to Danish national guidelines. Univariable and multivariable logistic regression models were used to calculate odds ratios for all outcomes. The researchers also performed a subgroup analysis for patients who were stable within 72 hours of admission.

A total of 771 patients were included in the study. Compared to pre-intervention, the unadjusted odds ratio (OR) for ≤ 7 days of total antibiotic treatment was 1.84 (95% confidence interval [CI], 1.34 to 2.54) for the whole population and 2.08 (95% CI, 1.41 to 3.10) for the stable patients. The OR for ≤ 3 days of intravenous antibiotics were 1.16 (95% CI, 0.87 to 1.54) and 1.38 (95% CI, 0.87 to 2.22), respectively. The OR for correct empiric antibiotics was 1.96 (95% CI, 1.45 to 2.68) and 1.82 for stable patients (95% CI, 1.23 to 2.69). 

"Due to the solid methodology, the results of our study strengthen the results of other publications on stewardship programmes in CAP," the authors wrote. "Similar interventions led to similar results in different settings worldwide. Therefore, we believe that the positive impact of stewardship programmes in CAP cannot be denied."
Nov 21 Int J Infect Dis study


Jordanian hospital ASP linked to lower broad-spectrum antibiotic use

A multifaceted antibiotic stewardship program (ASP) at a hospital in Jordan was associated with reduced use of several broad-spectrum antibiotics and reduced levels of carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients, researchers reported last week in the Journal of Antimicrobial Chemotherapy.

In a retrospective ecological assessment conducted at a King Abdullah University Hospital over 6 years (January 2014 through December 2019), researchers evaluated the impact of an ASP implemented in February 2018. The ASP included education, antibiotic guidelines, antibiotic restriction policy with prior approval, and audit and feedback. Using time-series methods, the researchers looked at the ASP's impacts on several restricted antibiotics, including imipenem/cilastatin, ertapenem, meropenem, vancomycin, piperacillin/tazobactam, colistin, and ciprofloxacin, and the effect of any reductions on CRAb in hospitalized patients.

After introduction of the ASP, statistically significant decrease in levels of use were observed for imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016), and third-generation cephalosporins (P = 0.0044).

The researchers also observed a statistically significant decrease in slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117). They also observed that a significant increasing trend in the use of piperacillin/tazobactam before the introduction  of the ASP (P = 0.0208) was halted after introduction of the ASP (P = 0.4574).

The introduction of the ASP was associated with a significant reduction in CRAb levels (P = 0.0237).

"Reports on effective and feasible antimicrobial stewardship interventions in [low- and middle-income countries] are limited, and this study provides evidence supporting successful implementation of an effective ASP," the authors of the study wrote. "The interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the increasing trends of use of other antibiotics, and were associated with a significant reduction in CRAb in the study site hospital."
Nov 21 J Antimicrob Chemother study

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