Effect of an educational antimicrobial stewardship program on antibiotic prescriptions' appropriateness in three medical units of a large university hospital: an interrupted time series analysis.
Francesca Giovannenze, Pierluigi Del Vecchio, Federico Frondizi, Emanuele Rando, Gabriele Maria Leanza, Maya Manuela Gross, Alessia Frater, Eugenia Magrini, Beatrice Liguoro, Flavio Sangiorgi, Massimo Fantoni, Carlo Torti, Rita Murri
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Abstract
Background: Antimicrobial Stewardship (AMS) Programs aim to enhance antibiotic prescription quality, reduce antibiotic use, and combat multidrug-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 evaluates 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 program 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 three months (December 2018 to February 2019). The primary outcome was the appropriateness of antibiotic prescriptions, with in-hospital survival as a secondary outcome.
Findings: Out of 609 antibiotic prescriptions evaluated, the program led to a significant and sustained reduction in inappropriate prescriptions in one unit (change in level (CL) -18.15%, p <0.01; change in trend (CT) -3.21%, p=0.01), while it failed to demonstrate a significant reduction in the other two units and globally in the three units.
Conclusions: The same educational AMS program 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 programs on appropriateness of antibiotic prescriptions.
期刊介绍：
The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.
The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that:
provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings;
provide new insight into cleaning, disinfection and decontamination;
provide new insight into the design of healthcare premises;
describe novel aspects of outbreaks of infection;
throw light on techniques for effective antimicrobial stewardship;
describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control;
improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change;
improve understanding of the use of IT systems in infection surveillance and prevention and control.
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