Example of antimicrobial stewardship program in a community hospital in Italy - 13/05/20
Exemple de mission de bon usage des antibiotiques dans un hôpital de première ligne en Italie
, C. Di Pietrantonj b , E. Ferrando c , A. Pernecco c , A. Salerno d , M. D’Orsi e , G. Chichino a Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | We described an antimicrobial stewardship program conducted in a community hospital and revealed that these activities can be implemented in hospitals other than university hospitals. |
• | We included a large number of observations (1,085), corresponding to 850 patients, in a sufficient time frame (two years) to see some changes in the adequacy of antibiotic prescription and antimicrobial resistance trend. |
• | We highlighted the strengths and weaknesses of the antimicrobial stewardship program to target new interventions and to be an example for other health facilities. |
Abstract |
Background |
Inappropriate use of antibiotics has caused the emergence of resistant strains of bacteria. The hospital of Alessandria, Italy, implemented an antimicrobial stewardship (AS) pilot program between 2013 and 2015 in the intensive care units (ICUs) and internal medicine departments of Casale Monferrato and Tortona. We aimed to describe the project, results at the end of the intervention, and its strengths and weaknesses.
Methods |
The protocol, designed by the local infection control committee, included three consecutive steps: local guidelines for empirical antibiotic therapy and list of prescription antibiotics with justification, monitoring of antibiotic consumption and antimicrobial resistance trend, and peer-to-peer audit sessions in the wards.
Results |
One thousand and eighty-five observations were made, corresponding to 850 patients admitted to the ICUs (16.7%) and internal medicine departments (83.3%). Appropriate antibiotic prescriptions increased by 6.4% between 2013 and 2015. The greatest improvement in appropriate prescriptions was observed for glycopeptides and fluoroquinolones (+17.4% and +16.2%, respectively). We reported 305 inappropriate prescriptions, with the most frequent errors being absence of an infectious process (33.3%), inadequate combination therapy (12.8%), and absence of microbiological investigations (8.5%). A reduced incidence of methicillin-resistant Staphylococcus aureus (MRSA) was also observed (p<0.0037).
Conclusions |
Antimicrobial stewardship programs contribute to improving antibiotic prescription and can be implemented in small community hospitals. Narrower interventions, focused on a single disease or single antibiotic should be encouraged.
Le texte complet de cet article est disponible en PDF.Keywords : Antimicrobial stewardship, Community hospital
Plan
Vol 50 - N° 4
P. 342-345 - juin 2020 Retour au numéro
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