The effect of an antimicrobial stewardship programme in two intensive care units of a teaching hospital: an interrupted time series analysis

Objectives We aimed at evaluating the effect of an antimicrobial stewardship (AMS) programme in two ICUs of a teaching hospital. Methods Between January 2017 and June 2018 we conducted a prospective, interventional, interrupted time series study, based on Prospective Audit and Feedback in two ICUs of an acute-care teaching hospital. The primary outcomes were the difference in the antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms. The secondary outcomes included the hospital mortality rate, the mean length of stay and the antibiotic expense. Results During the study, 231 audits were performed, evaluating 693 antibiotic prescriptions. The programme led to a global reduction in antibiotic consumption, with a change in level (CL) of -324.8 DDD/100 patients-day (PD), p=0.04, and particularly in the use of fluoroquinolone: (CL: -63.48 DDD/100 PD, p<0.001). A non-significant reduction was obtained for the consumption of carbapenems (CL: -34.7 DDD/100 PD, p=0.25) and third and fourth generation cephalosporins (CL: -27.3 DDD/100 PD, p=0.102). Furthermore, we registered a significant decrease in all BSI (CL: -5.8 events/100 PD, p=0.026) and in BSI due to MDR Gram negative organisms (CL: -2.96 events/100 PD, p=0.043). No difference was observed in the hospital mortality and length of stay. Conclusions Our study demonstrated that implementation of an AMS program in 2 ICUs of a teaching hospital induced a significant reduction in antibiotic consumption and in the incidence of BSI due to MDR Gram negative organisms, without any impact on the mortality rate.

Objectives: To evaluate the effect of an antimicrobial stewardship programme in two intensive care units (ICUs) of a teaching hospital. Methods: Between January 2017 and June 2018 we conducted a prospective, interventional, interrupted time-series study, based on Prospective Audit and Feedback in two ICUs of an acute-care teaching hospital. The primary outcomes were the difference in the antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms. The secondary outcomes included the hospital mortality rate, the mean length of stay and the antibiotic expense. Results: During the study, 231 audits were performed, evaluating 693 antibiotic prescriptions. The programme led to a global reduction in antibiotic consumption, with a change in level (CL) of –324.8 defined daily doses (DDD)/100 patient-days (PD), p 0.04, and particularly in the use of fluoroquinolone: (CL: –63.48 DDD/100 PD, p < 0.001). A non-significant reduction was obtained for the consumption of carbapenems (CL: –34.7 DDD/100 PD, p 0.25) and third- and fourth-generation cephalosporins (CL: –27.3 DDD/100 PD, p 0.102). Furthermore, we registered a significant decrease in all BSI (CL: –5.8 events/100 PD, p 0.026) and in BSI due to MDR Gram-negative organisms (CL: –2.96 events/100 PD, p 0.043). No difference was observed in the hospital mortality and length of stay. Conclusions: Our study demonstrated that implementation of an antimicrobial stewardship programme in two ICUs of a teaching hospital induced a significant reduction in antibiotic consumption and in the incidence of BSI due to MDR Gram-negative organisms, without any impact on the mortality rate.