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Clin Microbiol Infect. 2019 Jul 16. pii: S1198-743X(19)30398-2. doi: 10.1016/j.cmi.2019.07.009. [Epub ahead of print]

Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis.

Author information

1
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain.
2
Clinical Unit of Pharmacy, University Hospital Virgen del Rocio, Seville, Spain.
3
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, CSIC, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain.
4
Department of Critical Care, University Hospital Virgen Macarena, University of Seville, Seville, Spain.
5
Department of Pharmacy, Guadix-Loja Hospital, Granada, Spain.
6
Department of Preventive Medicine and Public Health, University Hospital Reina Sofia, Cordoba, Spain.
7
Pharmacy Service, Primary Healthcare District Aljarafe-Sevilla Norte, Mairena del Aljarafe, Seville, Spain.
8
Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, University of Seville, Seville, Spain.
9
El Valle Health Centre, Jaen, Spain.
10
Intensive Care Unit, University Hospital Puerta del Mar, University of Cadiz, Cadiz, Spain.
11
Intensive Care Unit, Jerez de la Frontera Hospital, Jerez de la Frontera, Cadiz, Spain.
12
Department of Comprehensive Health Plans, Supporting Services of the Andalusian Healthcare Service, Seville, Spain.
13
Department of Microbiology, Regional University Hospital of Malaga, Spain.
14
Clinical Unit of Prevention, Promotion and Health Surveillance, University Hospital Virgen de Valme, Seville, Spain.
15
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, CSIC, University of Seville, Institute of Biomedicine of Seville (IbiS), Seville, Spain. Electronic address: jmcisnerosh@gmail.com.

Abstract

OBJECTIVES:

Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain.

METHODS:

We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends.

RESULTS:

The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605).

CONCLUSIONS:

To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.

KEYWORDS:

Antimicrobial consumption; Antimicrobial stewardship programme; PIRASOA; Public healthcare system; Quality of prescription

PMID:
31323260
DOI:
10.1016/j.cmi.2019.07.009

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