Antimicrobial stewardship programme in critical care medicine: A prospective interventional study
Implantación de un programa de optimización de antimicrobianos en el paciente crítico: Estudio de intervención
J. Ruiza, P. Ramireza,
, M. Gordona, E. Villarreala, J. Frasquetb, J.L. Poveda-Andresc, M. Salavert-Lletíd, A. Catellanosa
Corresponding author
a Intensive Care Unit, Hospital Universitario y Politecnico La Fe, Valencia, Spain
b Microbiology Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
c Pharmacy Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
d Infectious Disease Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain
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"apellidos" => "Villarreal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Frasquet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "J.L." "apellidos" => "Poveda-Andres" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "M." "apellidos" => "Salavert-Lletí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "A." "apellidos" => "Catellanos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Intensive Care Unit, Hospital Universitario y Politecnico La Fe, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Microbiology Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Pharmacy Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Infectious Disease Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implantación de un programa de optimización de antimicrobianos en el paciente crítico: Estudio de intervención" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-26" "fechaAceptado" => "2017-07-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec989215" "palabras" => array:4 [ 0 => "Antimicrobial stewardship" 1 => "Antibiotics" 2 => "Antibiotic resistance" 3 => "Critical care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec989216" "palabras" => array:4 [ 0 => "Antimicrobial stewardship" 1 => "Antibióticos" 2 => "Resistencia bacteriana" 3 => "Paciente crítico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hospital antimicrobial stewardship programmes have achieved savings and a more rational use of antimicrobial treatments in general wards. The purpose of this report is to evaluate the experience of an antimicrobial stewardship programme in an intensive care unit (ICU).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective interventional, before-and-after study.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Scope</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">24-bed medical ICU in a tertiary hospital.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Intervention</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Prospective audit and feedback antimicrobial stewardship programme.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Endpoints</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Antimicrobial consumption, antimicrobial related costs, multi-drug resistant microorganisms (MDRM) prevalence, nosocomial infections incidence, ICU length of stay, and ICU mortality rates were compared before and after one-year intervention.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 218 antimicrobial episodes of 182 patients were evaluated in 61 team meetings. Antimicrobial stewardship suggestions were accepted in 91.5% of the cases. Total antimicrobial DDD/100 patient-days consumption was reduced from 380.6 to 295.2 (-22.4%; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.037). Antimicrobial stewardship programme was associated with a significant decrease in the prescription of penicillins plus b-lactamase inhibitors, linezolid, cephalosporins, and aminoglycosides. Overall antimicrobial spending was reduced by €119,636. MDRM isolation and nosocomial infections per 100 patient-days did not change after the intervention period. No changes in length of stay or mortality rate were observed.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">An ICU antimicrobial stewardship programme significantly reduced antimicrobial use without affecting inpatient mortality and length of stay. Our results further support the implementation of an antimicrobial stewardship programme in critical care units.</p></span>" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Scope" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Intervention" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Endpoints" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los programas de optimización de antimicrobianos (PROA) han demostrado ser herramientas eficaces para reducir el uso de antimicrobianos. El propósito de este estudio es evaluar el efecto de la implantación de un PROA en una unidad de cuidados intensivos (UCI).</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Diseño</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de intervención.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ámbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">UCI de 24 camas en un hospital terciario.</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Intervención</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Implantación de un PROA basado en auditorías prospectivas.</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Variables de interés principales</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El consumo de antimicrobianos y sus los costes, la prevalencia de colonización por bacterias multi-resistentes (BMR), la incidencia de infección nosocomial, la estancia en UCI y las tasas de mortalidad fueron comparadas antes y tras un año de implantación del programa.</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron un total de 218 episodios antimicrobianos de 182 pacientes en 61 reuniones. Él 91,5% de las sugerencias dadas por el equipo PROA fueron aceptadas por el prescriptor. El consumo total de antimicrobianos en DDD/100 estancias se redujo de 380,6 a 295,2 (-22,4%, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,037). La implantación del PROA se asoció con una disminución significativa en la prescripción de penicilinas/inhibidores de b-lactamasa, linezolid, cefalosporinas y aminoglucósidos. El gasto total en antimicrobianos se redujo en 119.636 €. La incidencia de colonización por BMR y de infecciones nosocomiales no cambiaron tras del período de intervención. No se observaron cambios en la duración de la estancia ni en la tasa de mortalidad.</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La implantación de un PROA en una UCI reduce significativamente el uso de antimicrobianos sin afectar a la evolución de los pacientes ingresados. Nuestros resultados apoyan la implementación de este tipo de programas en las unidades de pacientes críticos.</p></span>" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0050" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0055" "titulo" => "Intervención" ] 4 => array:2 [ "identificador" => "abst0060" "titulo" => "Variables de interés principales" ] 5 => array:2 [ "identificador" => "abst0065" "titulo" => "Resultados" ] 6 => array:2 [ "identificador" => "abst0070" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruiz J, Ramirez P, Gordon M, Villarreal E, Frasquet J, Poveda-Andres JL, et al. Implantación de un programa de optimización de antimicrobianos en el paciente crítico: Estudio de intervención. Med Intensiva. 2018;42:266–273.</p>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="sect0095">Further reading</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ruiz J, Ramirez P, Gordon M, Villarreal E, Frasquet J, Poveda-Andres JL, Salavert-Lletí M, Catellanos A, Antimicrobial stewardship programme in critical care medicine: A prospective interventional study, <span class="elsevierStyleItalic">Medicina Intensiva (English Edition)</span>, doi: 10.1016/j.medine.2017.07.004" ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004200000005/v1_201805310404/S2173572718301024/v1_201805310404/en/main.assets" "Apartado" => array:4 [ "identificador" => "411" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004200000005/v1_201805310404/S2173572718301024/v1_201805310404/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572718301024?idApp=WMIE" ]
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