Yusef Dawood, Hayajneh Wail A, Bani Issa Ali, Haddad Rami, Al-Azzam Sayer, Lattyak Elizabeth A, Lattyak William J, Gould Ian, Conway Barbara R, Bond Stuart, Conlon-Bingham Geraldine, Aldeyab Mamoon A
Department of Paediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Infection Control Division, King Abdullah University Hospital, Irbid, Jordan.
J Antimicrob Chemother. 2021 Jan 19;76(2):516-523. doi: 10.1093/jac/dkaa464.
To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients.
The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods.
Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237).
The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.
评估抗菌药物管理计划（ASP）对减少住院患者广谱抗生素使用的影响及其对耐碳青霉烯鲍曼不动杆菌（CRAb）的作用。
本研究是对一家三级教学医院6年（2014年1月至2019年12月）期间进行的回顾性生态评估。干预措施包括2018年2月实施的ASP，该计划至今仍在实施。该ASP包括几个组成部分，包括教育、抗生素指南、需事先批准的抗生素限制政策、对限制政策合规性的审核以及反馈。受限抗生素包括亚胺培南/西司他丁、厄他培南、美罗培南、万古霉素、替考拉宁、替加环素、黏菌素、阿米卡星、哌拉西林/他唑巴坦、左氧氟沙星和环丙沙星。采用时间序列方法对干预措施进行评估。
在实施ASP后，观察到以下抗生素的使用水平在统计学上显著下降：亚胺培南/西司他丁（P = 0.0008）、所有碳青霉烯类抗生素（P = 0.0001）、万古霉素（P = 0.0006）、黏菌素（P = 0.0016）和第三代头孢菌素（P = 0.0004）。在实施ASP后，观察到厄他培南（P = 0.0044）和环丙沙星（P = 0.0117）的斜率在统计学上显著下降。对于哌拉西林/他唑巴坦，在实施ASP之前有显著的上升趋势（P = 0.0208）。然而，在实施ASP后，这种上升趋势停止了（P = 0.4574）。实施ASP对降低CRAb水平有显著影响（P = 0.0237）。
引入的抗菌药物管理干预措施有助于减少几种广谱抗生素的使用，扭转了其他抗生素使用增加的趋势，并与CRAb的显著减少相关。
