Effect of an educational antimicrobial stewardship programme on antibiotic prescriptions' appropriateness in three medical units of a large university hospital: an interrupted time series analysis.

BACKGROUND

Antimicrobial stewardship (AMS) programmes aim to enhance antibiotic prescription quality, reduce antibiotic use, and combat multi-drug-resistant pathogens. However, the optimal AMS intervention for different clinical settings remains unclear, with previous studies predominantly focusing on antibiotic consumption rather than prescription appropriateness.

AIM

This study aimed to evaluate the impact of an education-based AMS intervention on antibiotic prescription appropriateness in three medical units of a 1500-bed university hospital.

METHODS

We conducted a retrospective interventional, interrupted time series study, to test the effect of an educational programme in three medical units of our 1500-bed university hospital in Rome, from June 2018 to October 2019. The intervention comprised six educational meetings held over 3 months (December 2018 to February 2019). The primary outcome was the appropriateness of antibiotic prescriptions, with in-hospital survival as a secondary outcome.

FINDINGS

Of 609 antibiotic prescriptions evaluated, the programme led to a significant and sustained reduction in inappropriate prescriptions in one unit (change in level: -18.15%, P<0.01; change in trend: -3.21%, P=0.01), while it failed to demonstrate a significant reduction in the other two units and globally in the three units.

CONCLUSION

The same educational AMS programme led to variable results in terms of antibiotic appropriateness in three medical units with similar structural and organizational features. Larger and more tailored high-quality AMS interventional studies are needed to better understand the impact of educational programmes on the appropriateness of antibiotic prescriptions.