School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil; AC Camargo Cancer Center, São Paulo, SP, Brazil.
Braz J Infect Dis. 2020 May-Jun;24(3):221-230. doi: 10.1016/j.bjid.2020.05.005. Epub 2020 Jun 3.
Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program.
An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period.
Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p=0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p<0.001). Expenditure decreased by $2089.99 (p<0.001) immediately after intervention and was maintained at this level over the intervention period ($-38.45; p=0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program.
The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.
抗菌药物管理计划是减少不合理使用抗菌药物和降低成本的有效方法；然而，中低收入国家的相关支持数据却很匮乏。本研究旨在评估广谱β-内酰胺类药物节约型抗菌药物管理计划实施后抗生素使用、细菌药敏谱和经济影响。
采用中断时间序列分析，评估 24 个月（抗菌药物管理计划实施前 12 个月和实施后 12 个月）期间的抗生素使用和支出。抗生素分为两类：β-内酰胺类抗生素和β-内酰胺类节约型抗生素。我们还比较了每个时期主要病原体的抗菌药物敏感性谱。
抗菌药物管理计划实施后，β-内酰胺类抗生素的使用量减少了 43.04 天/1000 患者天（p=0.04），而β-内酰胺类节约型抗生素的使用量在干预期间增加（斜率变化 6.17 天/1000 患者天，p<0.001）。干预后立即减少了 2089.99 美元的支出（p<0.001），并且在干预期间维持在这一水平（-38.45 美元；p=0.24）。我们还观察到，抗菌药物管理计划实施后，更多的病原体对头孢菌素类和氨基糖苷类药物敏感。
抗菌药物管理计划显著减少了广谱β-内酰胺类抗生素的使用，与支出减少和革兰氏阴性菌的敏感性谱维持有关。
