Clinical impact of an educational antimicrobial stewardship program associated with Infectious Diseases consultation targeting patients with cancer: results of a 9-year quasi-experimental study with an interrupted time-series analysis.
J Infect. 2019 Jul 09;:
Authors: Molina J, Noguer M, Lepe JA, Pérez-Moreno MA, Aguilar-Guisado M, Lasso de la Vega R, Peñalva G, Crespo JC, Gil-Navarro MV, Salvador J, Cisneros JM
OBJECTIVES: Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. However, their effectiveness or safety in immunocompromised hosts needs to be proved.
METHODS: An ecologic quasi-experimental study was performed from January 2009 to June 2017 in the Oncology department of a tertiary-care hospital. A stable program of Infectious Diseases consultation (IDC) already existed at this unit, and an educational ASP was added in 2011. Its main intervention consisted of face-to-face educational interviews. Antibiotic consumption was assessed through quarterly Defined Daily Doses (DDD) per 100 occupied bed-days. Mortality was evaluated in patients with bloodstream infections through the quarterly incidence density per 1,000 admissions, and the annual mortality rates at 7 and 30-days. Time-trends were analysed through segmented-regression analysis, and the impact of the ASP was assessed through before-after interrupted time-series analysis.
RESULTS: Mortality significantly decreased throughout the study period (-13.3% annual reduction for 7-day mortality rate, p<0.01; -8.1% annual reduction for 30-day mortality, p=0.03), parallel to a reduction in antibiotic consumption (quarterly reduction -0.4%, p=0.01), especially for broader-spectrum antibiotics. The before-after study settled a significant inflexion point on the ASP implementation for the reduction of antibiotic consumption (change in level 0.95 DDD, p=0.71; change in slope -1.98 DDD per quarter, p<0.01). The decreasing trend for mortality before the ASP also continued after its implementation.
CONCLUSIONS: The combination of an ASP with IDC improved antibiotic use among patients with cancer, and was accompanied by a reduction of mortality of bacteraemic infections. Implementation of the ASP was necessary to effectively change antibiotic use.
PMID: 31299411 [PubMed - as supplied by publisher]