Antimicrobial Stewardship al Policlinico Universitario di Modena: i due lavori che verranno presentati il 17-21 Settembre 2015 a San Diego al 55th Interscience Conference on Antimicrobial Agents and Chemotherapy.
Poster Number: S-1359a
Antimicrobial Stewardship in a Gastroenterology Department: Clinical Effects and Impact on Antimicrobials Consumption
A. Bedini, A. Brasacchio, N. De Maria, M. Del Buono, M. Bianchini, M. Mancini, G. Orlando, E. Franceschini, M. Meschiari, M. Codeluppi, E. Villa, C. Mussini.
A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. To target this, an antimicrobial stewardship program (ASP) has been implemented at the Gastroenterology Department of the University Hospital of Modena, Italy. Goal of this study was to evaluate the impact of the ASP on antimicrobial consumption and clinical outcome.
Between 1 October 2014 and 30 April 2015 (period B), 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 (DDDs) of antimicrobials, 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 A).
During the period B, 206 ID consultations were performed for 118 patients. At the first consultation, the antimicrobial prescription was confirmed in 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 escalated in 9 (7.6%). In comparison with the period A, during the period B antimicrobials consumption decreased from 152.53 to 110.59 DDDs per 100 patient-days (DDDs x100pd; p=0.117) and antifungals decreased from 53.76 to 33.85 DDDs x100pd (p=0.047). The greatest impact of the ASP was observed on carbapenems, that decreased from 20.53 to 6.26 DDDs x100pd (p=0.0027), glycopeptides (from 22.58 to 9.31 DDDs x100pd, p=0.0253), echinocandins (from 1.90 to 1.03 DDDs x100pd, p=0.62) and quinolones (from 38.17 to 21.45 DDDs x100pd, p=0.063). No significant differences were observed, during the period B and A, in mortality rate (3.19% and 3.38%, respectively) and in mean length of hospitalization (7.21 and 7.04 days, respectively).
To our knowledge, this is the first study performed on antimicrobial stewardship in a Gastronetrology Department. The study has shown that the ASP had a positive impact on the consumption of antibiotics, especially as regards carbapenems, glycopeptides and quinolones.
Poster Number: K-1249a
A multi-faced intervention to fight the spread of carbapenem resistant Klebsiella pneumoniae in an Italian endemic hospital: reduction of CRKP incidence thanks to implemented hand hygiene and antimicrobial stewardship
M. Meschiari, G. Orlando, S. Zona, C. Venturelli, E. Vecchi, G. Bianchini, P.Albinelli, A. Bedini, M. Codeluppi, P. Marchegiano, F. Rumpianesi, U.Frank, C. Mussini.
Italy is a country endemic for carbapenemase producing Klebsiella pneumoniae (CRKP). Aim of the study was to evaluate the role of a multi-faced infection control program to reduce CRKP incidence in a tertiary level University Hospital in Northern Italy
We applied a general approach to the whole hospital, and a targeted one in 5 selected wards from January 2012 to December 2014. We analyzed the effect of this intervention using time-series analysis considering the following monthly data: incidence of CRKP colonisations/infections, and CRKP-related BSI; hand hygiene compliance expressed by observations and by alcohol-based hand rub (AHR) consumption; number of CRKP screening; meropenem defined daily dose.
At the end of the study CRKP incidence was lower than the pre-intervention levels with a decrease of 42% and 70% for colonisations and BSI respectively (p<.001). In univariate and multivariate analysis factors significantly associated with mortality were: CRKP colonisation (HR= 6.5, CI 95%: 5.45-7.77, p<.0001) and the multi-faced intervention (HR=0.38, CI 95% 0.34-0.42, p<.0001). Increase of AHR use and reduction of meropenem consumption were associated with the decrease in CRKP colonisations/infections incidence. Similar results were obtained in the five wards involved in the targeted approach, where additionally hand hygiene compliance level correlated with the statistically significant decrease of CRKP incidence.
In endemic setting high level of hand hygiene compliance, universal screening at patients’ hospital admission, as well as antimicrobial stewardship program, targeted at hospital ecology and based on carbapenem sparing-regimens, are important tools to limit CRKP spreading.