Calò Federica, Onorato Lorenzo, Macera Margherita, Di Caprio Giovanni, Monari Caterina, Russo Antonio, Galdieri Anna, Giordano Antonio, Cuccaro Patrizia, Coppola Nicola
Department of Mental Health and Public Medicine-Infectious Diseases Unit, University of Campania Luigi Vanvitelli, 80138 Naples, Italy.
Infectious Diseases Unit, AORN Sant'Anna and San Sebastiano, 81100 Caserta, Italy.
Antibiotics (Basel). 2021 Mar 17;10(3):314. doi: 10.3390/antibiotics10030314.
To evaluate the effect that an education-based Antimicrobial stewardship program (ASP) implemented in two hospitals in southern Italy had on the quality and appropriateness of antibiotic prescription. We conducted a multicenter observational study in two hospitals in the Campania region. Only some departments of both hospitals were already participating in the ASP. We collected data on all patients admitted on the day of evaluation in antibiotic therapy or prophylaxis through a case report form. The primary outcome was to investigate the difference in the appropriateness of the antibiotic prescriptive practice in the departments that had joined the ASP and in those that had not participated in the project (non-ASP). The total number of patients assessed was 486. Of these, 78 (16.05%) were in antibiotic prophylaxis and 130 (26.7%) in antibiotic therapy. The prescriptive appropriateness was better in the units that had joined ASP than in those that had not, with respectively 65.8% versus 22.7% ( < 0.01). Patients in the non-ASP units more frequently received unnecessary antibiotics (44.9% versus 0%, = 0.03) and, as surgical prophylaxis, the use of antibiotics not recommended by the guidelines (44.2% versus 0%, = 0.036). Multivariable analysis of the factors associated with prescriptive appropriateness identified ASP units ( = 0.02) and bloodstream or cardiovascular infections ( = 0.03) as independent predictors of better prescriptive appropriateness. The findings of the present study reinforce the importance of adopting an educational ASP to improve the quality of antimicrobial prescription in clinical practice.
为评估在意大利南部两家医院实施的基于教育的抗菌药物管理计划（ASP）对抗生素处方质量和合理性的影响。我们在坎帕尼亚地区的两家医院开展了一项多中心观察性研究。两家医院只有部分科室参与了ASP。我们通过病例报告表收集了评估当天所有接受抗生素治疗或预防的患者的数据。主要结果是调查已加入ASP的科室与未参与该项目（非ASP科室）在抗生素处方实践合理性方面的差异。评估的患者总数为486例。其中，78例（16.05%）接受抗生素预防，130例（26.7%）接受抗生素治疗。加入ASP的科室处方合理性优于未加入的科室，分别为65.8%和22.7%（P<0.01）。非ASP科室的患者更频繁地接受不必要的抗生素（44.9%对0%，P = 0.03），并且作为手术预防措施，使用了指南不推荐的抗生素（44.2%对0%，P = 0.036）。对与处方合理性相关因素的多变量分析确定，ASP科室（P = 0.02）和血流感染或心血管感染（P = 0.03）是处方合理性更好的独立预测因素。本研究结果强化了采用教育性ASP以提高临床实践中抗菌药物处方质量的重要性。
