Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Antimicrob Chemother. 2024 Aug 1;79(8):1998-2007. doi: 10.1093/jac/dkae199.
Antimicrobial resistance (AMR), driven by inappropriate and overuse of antibiotics, poses a significant threat, especially to patients with acute leukaemia.
To evaluate the impact of antimicrobial stewardship programmes (ASPs) on antibiotic use and analyse temporal changes in bloodstream infections (BSI) caused by AMR organisms.
We performed a retrospective, interventional, longitudinal cohort study spanning an 11-year period. ASPs included optimizing antibiotic use, enhancing tracking and reporting systems and delineating leadership and accountability. A segmented regression model of interrupted time series was used to evaluate the trend of antibiotic consumption and BSI with AMR organisms after the interventions.
A total of 3296 BSI episodes with 454 419 days of therapy (DOT) from 7754 patients were obtained. ASPs were significantly associated with an immediate reduction [-70.03 DOT/1000 patient-days (PD), P = 0.036] and a decreasing trend (-11.65 DOT/1000 PD per quarter, P < 0.001) in overall antibiotic use. The increasing incidence of BSI with AMR before ASP intervention was notably curbed and revealed a decreasing trend (slope change: -0.06 BSI/1000 PD per quarter, P = 0.002). The decreasing trend was more significant for Enterobacterales: ciprofloxacin-resistant and ESBL-producing isolates showed a slope change of -0.06 BSI/1000 PD and -0.08 BSI/1000 PD per quarter, respectively (all P < 0.05). However, Pseudomonas aeruginosa BSI increased.
Multidimensional ASPs effectively reduced both the immediate and trends in overall antibiotic usage even in patients with acute leukaemia. Additionally, there was a notable decrease in the incidence of BSI caused by AMR organisms, particularly among Enterobacterales.
抗生素耐药性（AMR）是由抗生素的不当和过度使用所驱动的，对急性白血病患者构成了重大威胁。
评估抗菌药物管理计划（ASPs）对抗生素使用的影响，并分析由 AMR 病原体引起的血流感染（BSI）的时间变化。
我们进行了一项回顾性、干预性、纵向队列研究，时间跨度为 11 年。ASPs 包括优化抗生素使用、加强跟踪和报告系统以及明确领导责任和问责制。采用分段回归模型的中断时间序列分析评估干预后抗生素消耗和 AMR 病原体引起的 BSI 的趋势。
共获得 7754 例患者的 3296 例 BSI 发作和 454419 天的治疗（DOT）。ASPs 与总体抗生素使用的即刻减少（-70.03 DOT/1000 患者天，P=0.036）和下降趋势（每季度减少 11.65 DOT/1000 PD）显著相关。在 ASP 干预之前，BSI 与 AMR 相关的发病率增加趋势明显得到遏制，并呈现出下降趋势（斜率变化：每季度减少 0.06 BSI/1000 PD，P=0.002）。肠杆菌科的下降趋势更为显著：环丙沙星耐药和产 ESBL 的分离株的斜率变化分别为-0.06 BSI/1000 PD 和-0.08 BSI/1000 PD/季度（均 P<0.05）。然而，铜绿假单胞菌 BSI 增加。
多维 ASPs 有效地减少了急性白血病患者的即时和总体抗生素使用趋势。此外，由 AMR 病原体引起的 BSI 的发病率显著下降，尤其是肠杆菌科。
