Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90129 Palermo, Italy.
Fondazione Istituto G. Giglio, Contrada Pietra PollastraPisciotto, 90015 Cefalù, Italy.
Int J Environ Res Public Health. 2023 Jan 5;20(2):996. doi: 10.3390/ijerph20020996.
Healthcare-Acquired Infections (HAIs) are serious healthcare complications affecting hospital stay, in-hospital mortality, and costs. Root cause analysis has identified the inappropriate use of antibiotics as the main causative factor in the expansion of multi-drug-resistant organisms (MDRO) in our hospital. An Antimicrobial Stewardship (AMS) program was implemented to optimize antibiotic use, limit the development of resistance, improve therapeutic efficacy and clinical outcomes, and reduce costs.
The stewardship strategies were: antimicrobial oversight on "critical" antibiotics; the development of hospital guidelines on antibiotic selection with the production of a consensus document; the implementation of clinical and management control algorithms with visual impact and Business Intelligence methods; training and updating; and the monitoring of outcome measures and process indicators.
Clinical outcomes: length of stay reduced by 0.23 days, hospital readmission/first month rates decreased by 19%, and mortality for infections reduced by 8.8%. Microbiological Outcomes: colitis incidence reduced by 9.1%.Economic Outcomes: Reduction in antimicrobial costs by 35% on average fee/discharged patient.
The systematic application of the AMS program in a small hospital led to multiple improvements in clinical, microbiological, and economic outcome measures. The analysis of the core indicators for our hospital AMS program showed a significant adherence to the model and hospital recommendations.
医院获得性感染（HAI）是严重的医疗并发症，会影响住院时间、院内死亡率和医疗成本。根本原因分析确定，抗生素的不当使用是导致我们医院多药耐药菌（MDRO）扩张的主要因素。实施了抗菌药物管理（AMS）计划，以优化抗生素的使用，限制耐药性的发展，提高治疗效果和临床结果，并降低成本。
管理策略包括：对抗生素的“关键”进行监督；制定抗生素选择的医院指南，并制定共识文件；实施临床和管理控制算法，并采用可视化和商业智能方法；培训和更新；以及监测结果措施和过程指标。
临床结果：住院时间缩短了 0.23 天，医院再入院/第一个月的比例下降了 19%，感染死亡率下降了 8.8%。微生物学结果：结肠炎的发病率降低了 9.1%。经济学结果：平均每位出院患者的抗菌药物费用降低了 35%。
在一家小医院系统地应用 AMS 计划，在临床、微生物学和经济学结果方面都取得了多项改善。对我们医院 AMS 计划的核心指标进行分析，显示出对模型和医院建议的高度依从性。
