Guisado-Gil Ana Belén, Aguilar-Guisado Manuela, Peñalva Germán, Lepe José Antonio, Espigado Ildefonso, Rodríguez-Arbolí Eduardo, González-Campos José, Rodríguez-Torres Nancy, Montero-Cuadrado María Isabel, Falantes-González José Francisco, Reguera-Ortega Juan Luis, Gil-Navarro María Victoria, Molina José, Pérez-Simón José-Antonio, Cisneros José Miguel
Department of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, 41013 Seville, Spain.
Department of Pharmacy, University Hospital Virgen del Rocio, 41013 Seville, Spain.
Antibiotics (Basel). 2021 Jan 30;10(2):136. doi: 10.3390/antibiotics10020136.
Antimicrobial stewardship programs (ASPs) in hematological patients are especially relevant. However, information about ASPs in this population is scarce. For 11 years, we quarterly assessed antimicrobial consumption and incidence and death rates of multidrug-resistant (MDR) bloodstream infections (BSI) in the hematology Department. Healthcare activity indicators were also monitored yearly. We performed an interrupted time-series analysis. Antimicrobials showed a sustained reduction with a relative effect of -62.3% (95% CI -84.5 to -40.1) nine years after the inception of the ASP, being especially relevant for antifungals (relative effect -80.4%, -90.9 to -69.9), quinolones (relative effect -85.0%, -102.0 to -68.1), and carbapenems (relative effect -68.8%, -126.0 to -10.6). Incidence density of MDR BSI remained low and stable (mean 1.10 vs. 0.82 episodes per 1000 occupied bed days for the pre-intervention and the ASP period, respectively) with a quarterly percentage of change of -0.3% (95% CI -2.0 to 1.4). Early and late mortality of MDR BSI presented a steady trend (quarterly percentage of change -0.7%, 95% CI -1.7 to 0.3 and -0.6%, 95% CI -1.5 to 0.3, respectively). Volume and complexity of healthcare activity increased over the years. The ASP effectively achieved long-term reductions in antimicrobial consumption and improvements in the prescription profile, without increasing the mortality of MDR BSI.
抗菌药物管理计划（ASP）在血液病患者中尤为重要。然而，关于这一人群中ASP的信息却很少。在11年的时间里，我们每季度评估血液科抗菌药物的使用情况以及耐多药（MDR）血流感染（BSI）的发生率和死亡率。每年还监测医疗活动指标。我们进行了中断时间序列分析。在ASP启动九年后，抗菌药物的使用持续减少，相对降幅为-62.3%（95%置信区间为-84.5至-40.1），这在抗真菌药物（相对降幅-80.4%，-90.9至-69.9）、喹诺酮类药物（相对降幅-85.0%，-102.0至-68.1）和碳青霉烯类药物（相对降幅-68.8%，-126.0至-10.6）方面尤为明显。MDR BSI的发病密度保持在较低且稳定的水平（干预前和ASP期间每1000个占用床日的平均发病次数分别为1.10次和0.82次），季度变化率为-0.3%（95%置信区间为-2.0至1.4）。MDR BSI的早期和晚期死亡率呈现出稳定的趋势（季度变化率分别为-0.7%，95%置信区间为-1.7至0.3和-0.6%，95%置信区间为-1.
