Implementation of an Antimicrobial Stewardship Program in the Vascular Surgery Ward of a university tertiary care hospital in Pavia, Northern Italy
Abstract Background. Given the unquestionable issue of antimicrobial resistance and the importance of instituting antimicrobial stewardship programs (ASPs), the commitment of multidisciplinary teams in achieving these interventions is often inadequately considered, especially in surgical wards, where antibiotic misuse is a well-recognized phenomenon. Methods. A quasi-experimental quality-improvement study was applied in the Vascular Surgery ward of Fondazione IRCCS Policlinico San Matteo, a tertiary care hospital in Pavia, Italy, with the aim to evaluate clinical, microbiological, and pharmacological outcomes before and after the implementation of an ASP. The antimicrobial stewardship activity was conducted twice a week for twelve months. It consisted of either a pro-active systematic revision of all the ongoing antimicrobial prescriptions by the infectious diseases (ID) consultant and education and training of the healthcare workers of the Vascular Surgery ward in antimicrobial stewardship and infection control. For comparison between the study periods, Student t test (Mann-Whitney test for skewed distributions) was used for quantitative variables (ANOVA or Kruskall-Wallis for > 2 groups respectively), and Pearson’s chi-squared test (Fisher exact test where appropriate) for categorical variables. In all cases, 2-tailed tests were used. P-value significance cut-off was 0.05. Results. During the 12-month period following the start of the ASP, 186 ID consultations were performed, mostly aimed at de-escalating an ongoing antimicrobial therapy (39, 20.97%). A statistically significant reduction in isolates of carbapenem-resistant Pseudomonas aeruginosa (p-value 0.003) and no Clostridioides difficile infections were reported. No statistically significant changes were observed in terms of length of stay and all-cause in-hospital mortality. A significant decrease in the administration of carbapenems (mean DDDs from 4.53 to 1.51, p-value 0.01), daptomycin (mean DDDs from 2.64 to 0.05, p-value < 0.01) and linezolid (mean DDDs from 0.49 to 0.26, p-value 0.43) was registered. During the intervention period, a significant reduction in antimicrobial costs was observed. Conclusions. The implementation of a 12-month ASP brought significant clinical and economic results in the Vascular Surgery ward of our hospital, highlighting the benefits of a multidisciplinary teamwork..
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Preprint| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
ResearchSquare.com - (2023) vom: 25. Sept. Zur Gesamtaufnahme - year:2023 |
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| Sprache: |
Englisch |
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| Beteiligte Personen: |
Vecchia, Marco [VerfasserIn] |
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| doi: |
10.21203/rs.3.rs-1636035/v1 |
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XRA035997621 |
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| 520 | |a Abstract Background. Given the unquestionable issue of antimicrobial resistance and the importance of instituting antimicrobial stewardship programs (ASPs), the commitment of multidisciplinary teams in achieving these interventions is often inadequately considered, especially in surgical wards, where antibiotic misuse is a well-recognized phenomenon. Methods. A quasi-experimental quality-improvement study was applied in the Vascular Surgery ward of Fondazione IRCCS Policlinico San Matteo, a tertiary care hospital in Pavia, Italy, with the aim to evaluate clinical, microbiological, and pharmacological outcomes before and after the implementation of an ASP. The antimicrobial stewardship activity was conducted twice a week for twelve months. It consisted of either a pro-active systematic revision of all the ongoing antimicrobial prescriptions by the infectious diseases (ID) consultant and education and training of the healthcare workers of the Vascular Surgery ward in antimicrobial stewardship and infection control. For comparison between the study periods, Student t test (Mann-Whitney test for skewed distributions) was used for quantitative variables (ANOVA or Kruskall-Wallis for > 2 groups respectively), and Pearson’s chi-squared test (Fisher exact test where appropriate) for categorical variables. In all cases, 2-tailed tests were used. P-value significance cut-off was 0.05. Results. During the 12-month period following the start of the ASP, 186 ID consultations were performed, mostly aimed at de-escalating an ongoing antimicrobial therapy (39, 20.97%). A statistically significant reduction in isolates of carbapenem-resistant Pseudomonas aeruginosa (p-value 0.003) and no Clostridioides difficile infections were reported. No statistically significant changes were observed in terms of length of stay and all-cause in-hospital mortality. A significant decrease in the administration of carbapenems (mean DDDs from 4.53 to 1.51, p-value 0.01), daptomycin (mean DDDs from 2.64 to 0.05, p-value < 0.01) and linezolid (mean DDDs from 0.49 to 0.26, p-value 0.43) was registered. During the intervention period, a significant reduction in antimicrobial costs was observed. Conclusions. The implementation of a 12-month ASP brought significant clinical and economic results in the Vascular Surgery ward of our hospital, highlighting the benefits of a multidisciplinary teamwork. | ||
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