Impact of a hospital-wide antibiotic restriction policy program on the resistance rates of nosocomial Gram-negative bacteria

被引:17
作者
Antoniadou, Anastasia [1 ]
Kanellakopoulou, Kyriaki [1 ]
Kanellopoulou, Maria [2 ]
Polemis, Michael [3 ]
Koratzanis, George [2 ]
Papademetriou, Evangelia [1 ]
Poulakou, Garyfalia [1 ]
Giannitsioti, Efthimia [1 ]
Souli, Maria [1 ]
Vatopoulos, Alkiviadis [3 ]
Giamarellou, Helen [4 ]
机构
[1] Univ Gen Hosp Attikon, Dept Internal Med 4, Athens, Greece
[2] Simanoglio Gen Hosp, Athens, Greece
[3] Natl Sch Publ Hlth, Athens, Greece
[4] Hygeia Hosp, Athens 15123, Greece
关键词
Antibiotic restriction; microbial resistance; Gram-negatives; antibiotic policies; antibiotic consumption; INFECTIOUS-DISEASES SOCIETY; KLEBSIELLA-PNEUMONIAE; ESCHERICHIA-COLI; 3RD-GENERATION; INTERVENTIONS; PATTERNS; QUALITY;
D O I
10.3109/00365548.2012.760845
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: To evaluate the impact of an antibiotic restriction policy on antibiotic consumption and Gram-negative resistance rates, in an environment of antibiotic overconsumption and increasing resistance rates for nosocomial pathogens. Methods: The study was a 'before and after' trial of 18-month duration; the antibiotic restriction policy program was implemented in 1998-2000 and was based on a government program addressed by the Ministry of Health to public hospitals on a national basis. This included prescribing of all newer antibiotics on an order form, auditing of the order forms and consultation with infectious diseases (ID) specialists, dispensing of treatment and prophylaxis guidelines, feedback, and face-to-face education. Antibiotic consumption and Gram-negative resistance rates were recorded before and after the intervention. Results: Despite the addition of a new 40-bed ID department in the hospital during the 'after' period, the consumption of restricted antibiotics was significantly reduced by 42% (and their cost by 31%). Gram-negative resistance rates for Pseudomonas, Klebsiella, and Enterobacter, serving as index microorganisms for Gram-negative nosocomial pathogens, were significantly reduced during the 'after' period, even against antibiotics for which there was an increase in consumption. Conclusions: Multidisciplinary restriction programs can reduce antibiotic consumption and Gram-negative resistance rates in the hospital setting.
引用
收藏
页码:438 / 445
页数:8
相关论文
共 23 条
[1]   Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis [J].
Ansari, F ;
Gray, K ;
Nathwani, D ;
Phillips, G ;
Ogston, S ;
Ramsay, C ;
Davey, P .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2003, 52 (05) :842-848
[2]  
Antoniadou A, 1997, 37 INT C ANT AG CHEM
[3]   A hospitalwide intervention program to optimize the quality of antibiotic use:: Impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance [J].
Bantar, C ;
Sartori, B ;
Vesco, E ;
Heft, C ;
Saúl, M ;
Salamone, F ;
Oliva, ME .
CLINICAL INFECTIOUS DISEASES, 2003, 37 (02) :180-186
[4]   Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America [J].
Boucher, Helen W. ;
Talbot, George H. ;
Bradley, John S. ;
Edwards, John E., Jr. ;
Gilbert, David ;
Rice, Louis B. ;
Scheld, Michael ;
Spellberg, Brad ;
Bartlett, John .
CLINICAL INFECTIOUS DISEASES, 2009, 48 (01) :1-12
[5]  
Clinical and Laboratory Standards Institute, 2005, M100S15 CLSI
[6]   Systematic review of antimicrobial drug prescribing in hospitals [J].
Davey, P ;
Brown, E ;
Fenelon, L ;
Finch, R ;
Gould, I ;
Holmes, A ;
Ramsay, C ;
Taylor, E ;
Wiffen, P ;
Wilcox, M .
EMERGING INFECTIOUS DISEASES, 2006, 12 (02) :211-216
[7]   Interventions to improve antibiotic prescribing practices for hospital inpatients [J].
Davey, Peter ;
Brown, Erwin ;
Charani, Esmita ;
Fenelon, Lynda ;
Gould, Ian M. ;
Holmes, Alison ;
Ramsay, Craig R. ;
Wiffen, Philip J. ;
Wilcox, Mark .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2013, (04)
[8]   Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship [J].
Dellit, Timothy H. ;
Owens, Robert C. ;
McGowan, John E., Jr. ;
Gerding, Dale N. ;
Weinstein, Robert A. ;
Burke, John P. ;
Huskins, W. Charles ;
Paterson, David L. ;
Fishman, Neil O. ;
Carpenter, Christopher F. ;
Brennan, P. J. ;
Billeter, Marianne ;
Hooton, Thomas M. .
CLINICAL INFECTIOUS DISEASES, 2007, 44 (02) :159-177
[9]  
European Centre for Disease Control and Prevention (ECDC), 2011, EUR SURV ANT CONC NE
[10]   Control of extended-spectrum β-lactamase-producing Klebsiella pneumoniae using a computer-assisted management program to restrict third-generation cephalosporin use [J].
Kim, Jeong Yeon ;
Sohn, Jang Wook ;
Park, Dae Won ;
Yoon, Young Kyung ;
Kim, Young Mi ;
Kim, Min Ja .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2008, 62 (02) :416-421