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Identifier 000456698
Title A study on the impact of the implementation of an antibiotic stewardship program for adult patients in a greek academic hospital
Alternative Title Μελέτη των επιπτώσεων της εφαρμογής προγράμματος διαχείρισης της ορθολογικής χρήσης αντιβιοτικών (Antibiotic Stewardship) για ενήλικες ασθενείς σε πανεπιστημιακό νοσηλευτικό ίδρυμα της Ελλάδος
Author Σπερνοβασίλης, Νικόλαος
Thesis advisor Κοφτερίδης, Διαμαντής
Reviewer Γκίκας, Αχιλλέας
Χαμηλός, Γεώργιος
Αντωνίου, Αικατερίνη
Κριτσωτάκης, Ευάγγελος
Φιλιππάτος, Θεοδώσιος
Ιωάννου, Πέτρος
Abstract Introduction: Antimicrobial resistance (AMR) is one of the most important public health problems worldwide. The misuse and overuse of antimicrobials, mainly antibiotics, is one of the main drivers of the AMR. Greece is among the countries characterized by high rate of multidrug-resistant organisms (MDROs) in the community and the hospital sector, and by increased use of broad-spectrum antibiotics, including carbapenems. The aim of this dissertation was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) for adult patients in a Greek academic hospital on the quality of antimicrobial prescribing, the overall consumption of last-line antibiotics with activity against Gram-negative bacteria, patient outcomes, and on the behavior of the treating physicians regarding the management of infections caused by MDROs. Methods: This dissertation included three different studies conducted in the University Hospital of Heraklion, in Greece. A carbapenem-focused ASP was implemented between 1st of January 2020 and 31st of December 2020 in all adult wards of the hospital. A repeated point prevalence survey (PPS) was performed among all adult inpatients before and after implementing the ASP to assess its impact on the quality of antimicrobial prescribing. Furthermore, a quasi-experimental, before–after cohort study was undertaken, comparing the 12-month pre-intervention period with the 12-month intervention period regarding the consumption of broad-spectrum antibiotics with activity against Gram-negative bacteria and patient outcomes. Finally, a cross-sectional study was conducted among all resident and specialist doctors of our hospital’s adult wards to evaluate the impact of this carbapenem-focused ASP on their perceptions, attitudes, and practices towards the management of infections caused by difficult-to-treat bacteria. Results: The repeated PPS showed a statistically significant improvement in several quality indicators (QIs) related to antimicrobial prescribing after the implementation of the ASP. Specifically, the rate of documentation in patient files of the reason and of the stop/review date of antimicrobial administration was significantly higher (p < 0.001) in the second PPS, while full compliance to national or international treatment guidelines was also significantly increased from 61.8% to 73.6% (p = 0.003). The quasi-experimental cohort study demonstrated a statistically significant decrease of −4.9 Define Daily Doses (DDD)/100 patient-days (PD) (95% CI −7.3 to −2.6; P = 0.007) in carbapenem use and a statistically significant increase only in the use of piperacillin/tazobactam [+2.1 DDD/100 PD (95% CI 1.0–3.3; P = 0.010)], while the consumption of ceftolozane/tazobactam, ceftazidime/avibactam, tigecycline, and colistin had no statistically significant shifts. Thirty-day mortality following initiation of carbapenem treatment and all-cause in-hospital mortality remained unaltered after ASP implementation. In contrast, the length of hospital stay increased (median 17.0 versus 19.0 days; P < 0.001), while the risk of infection related readmission within 30 days of hospital discharge decreased (24.6% versus 16.8%; P = 0.007). Importantly, in the post-implementation period, acceptance of the ASP intervention by the treating physicians was associated with lower daily hazard of in hospital death [cause-specific HR (csHR) 0.49; 95% CI 0.30–0.80], lower odds of 30-day mortality (OR 0.36; 95% CI 0.18–0.70) and higher rate of treatment success (csHR 2.45; 95% CI 1.59–3.77). Regarding the impact of the stewardship intervention on the behavior of our hospital’s doctors when managing infections caused by MDROs, ASP implementation prompted most of them to monitor the continuously evolving microbiological data of their patients more closely. It also shifted them towards a multidisciplinary and personalized care of patients with infections caused by MDROs and towards a more rigorous implementation of infection prevention and control (IPC) measures. The vast majority of our colleagues (98.5%) wanted the ASP to be continued and further developed, even though at that time they were under the pressure of the COVID-19 pandemic. Conclusions: This dissertation demonstrated the favorable effect of a carbapenem-focused ASP on the use of last-line antimicrobials with activity against Gram-negative MDROs on the overall quality of antimicrobial prescribing, even during the COVID-19 pandemic. Notably, the intervention described here was correlated with improved patient outcomes. Finally, the implementation of the ASP in our hospital had a positive impact on doctors’ perceptions, attitudes, and practices towards the management of patients with difficult-to-treat infections.
Language English
Subject Antimicrobial resistance
Multidrug -resistant
Επιμελητεία αντιβιοτικών
Μικροβιακή αντοχή
Πολυανθεκτικά
Issue date 2023-07-28
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
Permanent Link https://elocus.lib.uoc.gr//dlib/7/5/7/metadata-dlib-1688119244-85406-2378.tkl Bookmark and Share
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