ANTIMICROBIAL STEWARDSHIP IN A GASTROENTEROLOGY DEPARTMENT

Impatto sul consumo degli antibiotici, sulle resistenze antimicrobiche e sull’outcome clinico dopo un anno di attività.

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Digestive and Liver Diseases (30 June 2016)

A. Bedini, N. De Maria, M. Del Buono, M. Bianchini, M. Mancini, C. Binda, A. Brasacchio, G. Orlando, E. Franceschini, M. Meschiari, A. Sartini, S. Zona, S. Paioli, E. Villa, I.C. Gyssens, C. Mussini

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Abstract

BACKGROUND. A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials.

AIMS. To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department.

METHODS. Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A).

RESULTS. During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p = 0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p = 0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p = 0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p = 0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate.

CONCLUSIONS. ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality.