title: Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome.
abstract: BACKGROUND
  A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials.
  
  
  OBJECTIVE
  To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department.
  
  
  METHODS
  Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A).
  
  
  RESULTS
  During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p=0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p=0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p=0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p=0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate.
  
  
  CONCLUSIONS
  ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality.
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy. Electronic address: andreabedini@yahoo.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bedini
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: De Maria
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Del Buono
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Bianchini
authors.affiliation: Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Mancini
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Binda
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Brasacchio
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Franceschini
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Meschiari
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sartini
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zona
authors.affiliation: Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Paioli
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Villa
authors.affiliation: Department of Infectious Diseases, Hasselt University, Belgium.
authors.forename: Inge C
authors.initials: IC
authors.lastname: Gyssens
authors.affiliation: Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Mussini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology / Q000458:organization & administration*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D054539:Medication Therapy Management / Q000592:standards*; D008875:Middle Aged; D011446:Prospective Studies; D012017:Referral and Consultation; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Antifungals; Antimicrobial stewardship; Carbapenems; Gastroenterology; MDR-microorganisms