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A carbapenem-focused antimicrobial stewardship programme implemented during the COVID-19 pandemic in a setting of high endemicity for multidrug-resistant Gram-negative bacteria.
- Source :
-
Journal of Antimicrobial Chemotherapy (JAC) . Apr2023, Vol. 78 Issue 4, p1000-1008. 9p. - Publication Year :
- 2023
-
Abstract
- Background Greece is among the countries characterized by high rates of antimicrobial resistance and high consumption of antibiotics, including carbapenems. Objectives To measure the impact of a carbapenem-focused antimicrobial stewardship programme (ASP) on the antibiotic consumption and patient outcomes in a Greek tertiary hospital during the COVID-19 pandemic. Methods A quasi-experimental, before–after study, comparing a 12 month pre-intervention period with a 12 month intervention period in which a carbapenem-focused ASP was implemented. Results A total of 1268 patients were enrolled. The proportion of admitted patients who received carbapenems decreased from 4.1% (842 of 20 629) to 2.3% (426 of 18 245) (−1.8%; P < 0.001). A decrease of −4.9 DDD/100 patient-days (PD) (95% CI −7.3 to −2.6; P = 0.007) in carbapenem use and an increase in the use of piperacillin/tazobactam [+2.1 DDD/100 PD (95% CI 1.0–3.3; P = 0.010)] were observed. Thirty-day mortality following initiation of carbapenem treatment and all-cause in-hospital mortality remained unaltered after ASP implementation. In contrast, 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). In the post-implementation period, acceptance of the ASP intervention 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). Conclusions Implementing and maintaining a carbapenem-focused ASP is feasible, effective and safe in settings with high rates of antimicrobial resistance, even during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 03057453
- Volume :
- 78
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Journal of Antimicrobial Chemotherapy (JAC)
- Publication Type :
- Academic Journal
- Accession number :
- 162875348
- Full Text :
- https://doi.org/10.1093/jac/dkad035