Spernovasilis, N. orcid.org/0000-0002-6981-8535, Kritsotakis, E.I. orcid.org/0000-0002-9526-3852, Mathioudaki, A. et al. (6 more authors) (2023) A carbapenem-focused antimicrobial stewardship programme implemented during the COVID-19 pandemic in a setting of high endemicity for multidrug-resistant Gram-negative bacteria. Journal of Antimicrobial Chemotherapy, 78 (4). pp. 1000-1008. ISSN 0305-7453
Abstract
Background Greece is among the countries characterized by high rates of antimicrobial resistance and high consumption of antibiotics, including carbapenems.
Objectives To measure the impact of a carbapenem-focused antimicrobial stewardship programme (ASP) on the antibiotic consumption and patient outcomes in a Greek tertiary hospital during the COVID-19 pandemic.
Methods A quasi-experimental, before–after study, comparing a 12 month pre-intervention period with a 12 month intervention period in which a carbapenem-focused ASP was implemented.
Results A total of 1268 patients were enrolled. The proportion of admitted patients who received carbapenems decreased from 4.1% (842 of 20 629) to 2.3% (426 of 18 245) (−1.8%; P < 0.001). A decrease of −4.9 DDD/100 patient-days (PD) (95% CI −7.3 to −2.6; P = 0.007) in carbapenem use and an increase in the use of piperacillin/tazobactam [+2.1 DDD/100 PD (95% CI 1.0–3.3; P = 0.010)] were observed. Thirty-day mortality following initiation of carbapenem treatment and all-cause in-hospital mortality remained unaltered after ASP implementation. In contrast, length of hospital stay increased (median 17.0 versus 19.0 days; P < 0.001), while the risk of infection-related readmission within 30 days of hospital discharge decreased (24.6% versus 16.8%; P = 0.007). In the post-implementation period, acceptance of the ASP intervention was associated with lower daily hazard of in-hospital death [cause-specific HR (csHR) 0.49; 95% CI 0.30–0.80], lower odds of 30 day mortality (OR 0.36; 95% CI 0.18–0.70) and higher rate of treatment success (csHR 2.45; 95% CI 1.59–3.77).
Conclusions Implementing and maintaining a carbapenem-focused ASP is feasible, effective and safe in settings with high rates of antimicrobial resistance, even during the COVID-19 pandemic.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. |
Keywords: | Humans; Carbapenems; Gram-Negative Bacterial Infections; Hospital Mortality; Antimicrobial Stewardship; Pandemics; COVID-19; Anti-Bacterial Agents; Gram-Negative Bacteria |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 05 Jun 2023 11:43 |
Last Modified: | 05 Jun 2023 11:43 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1093/jac/dkad035 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:199760 |