Do specific antimicrobial stewardship interventions have an impact on carbapenem resistance in Gram-negative bacilli? A multicentre quasi-experimental ecological study: time-trend analysis and characterization of carbapenemases
Year: 2021
Type: article
Abstract: BACKGROUND: Carbapenem-resistant Gram-negative bacilli (CR-GNB) are among the most threatening microorganisms worldwide and carbapenem use facilitates their spread. Antimicrobial stewardship programmes (ASPs) can help to optimize the use of antibiotics. This study evaluates the impact of a multifaceted educational ASP on carbapenem use and on the epidemiology of CR-GNB. METHODS: We conducted a quasi-experimental, time-series study in seven hospitals, from January 2014 to September 2018. The key intervention was composed of educational interviews promoting the appropriate use of carbapenems. The primary endpoints were carbapenem consumption and incidence density (ID) of CR-GNB. All non-duplicated CR-GNB clinical isolates were tested using phenotypic assays and PCR for the presence of carbapenemases. Joinpoint regression and interrupted time-series analyses were used to determine trends. RESULTS: A decrease in carbapenem consumption throughout the study period [average quarterly percentage change (AQPC) -1.5%, P < 0.001] and a -8.170 (-16.064 to -0.277) level change following the intervention were observed. The ID of CR-Acinetobacter baumannii decreased (AQPC -3.5%, P = 0.02) and the overall ID of CR-GNB remained stable (AQPC -0.4%, P = 0.52). CR-GNB, CR-Pseudomonas aeruginosa and CR-A. baumannii IDs per hospital correlated with the local consumption of carbapenems. The most prevalent carbapenem resistance mechanisms were OXA-23 for CR-A. baumannii (76.1%), OXA-48 for CR-Klebsiella pneumoniae (66%) and no carbapenemases for CR-P. aeruginosa (91.7%). The epidemiology of carbapenemases was heterogeneous throughout the study, especially for carbapenemase-producing Enterobacteriaceae. CONCLUSIONS: In conclusion, a multifaceted, educational interview-based ASP targeting carbapenem prescribing reduced carbapenem use and the ID of CR-A. baumannii.
DOI: 10.1093/jac/dkab073
Authors: Rocío Álvarez-Marín, Lorena López-Cerero, Francisca Guerrero-Sánchez, Begoña Palop-Borras, María Dolores Rojo-Martín, Andrés Ruiz-Sancho, Carmen Herrero-Rodríguez, María Victoria García, Ana María Lazo-Torres, Inmaculada López, Lina Martín-Hita, Enrique Nuño-Álvarez, Waldo Sánchez-Yebra, Fátima Galán-Sánchez, José María Reguera-Iglesias, José Antonio Lepe, Germán Peñalva, Álvaro Pascual, José Miguel Cisneros, the CarbaPIRASOA team, María Eugenia Rodríguez-Mateos, Carmen Gallego-Fernández, Félix Gómez-de Rueda, Raquel Saldaña Soria, María Antonia Pérez-Moreno, Felipe Fernández-Cuenca, Pablo Nieto Guindo, Alejandro Peña, Ignacio Márquez-Gómez, Lucía Valiente, Sergio Ferra-Murcia, Miguel Ángel Rodríguez, Isabel Gea-Lázaro, José Molina-Gil Bermejo
Institutions: Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Hospital Universitario Virgen Macarena, Hospital Universitario Puerta del Mar, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario de Jaén, Hospital Clínico Universitario Virgen de la Victoria, Complejo Hospitalario Torrecárdenas
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3137945665