title: An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility.
abstract: OBJECTIVE To assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital. DESIGN Quasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation. SETTING 150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries. INTERVENTION Beginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation. RESULTS Antibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008). CONCLUSIONS An ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital. Infect Control Hosp Epidemiol. 2016;1-7.
authors.affiliation: 1Infectious Diseases Unit,Teaching Hospital S. Orsola-Malpighi,Alma Mater Studiorum University of Bologna;Bologna,Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tedeschi
authors.affiliation: 1Infectious Diseases Unit,Teaching Hospital S. Orsola-Malpighi,Alma Mater Studiorum University of Bologna;Bologna,Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Trapani
authors.affiliation: 1Infectious Diseases Unit,Teaching Hospital S. Orsola-Malpighi,Alma Mater Studiorum University of Bologna;Bologna,Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Giannella
authors.affiliation: 1Infectious Diseases Unit,Teaching Hospital S. Orsola-Malpighi,Alma Mater Studiorum University of Bologna;Bologna,Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cristini
authors.affiliation: 1Infectious Diseases Unit,Teaching Hospital S. Orsola-Malpighi,Alma Mater Studiorum University of Bologna;Bologna,Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tumietto
authors.affiliation: 1Infectious Diseases Unit,Teaching Hospital S. Orsola-Malpighi,Alma Mater Studiorum University of Bologna;Bologna,Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bartoletti
authors.affiliation: 2Montecatone Rehabilitation Institute;Imola,Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Liverani
authors.affiliation: 3Laboratory Analysis of Clinical Chemistry and Microbiology,S. Maria della Scaletta Hospital;Imola,Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Pignanelli
authors.affiliation: 2Montecatone Rehabilitation Institute;Imola,Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Toni
authors.affiliation: 2Montecatone Rehabilitation Institute;Imola,Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pederzini
authors.affiliation: 2Montecatone Rehabilitation Institute;Imola,Italy.
authors.forename: Augusto
authors.initials: A
authors.lastname: Cavina
authors.affiliation: 1Infectious Diseases Unit,Teaching Hospital S. Orsola-Malpighi,Alma Mater Studiorum University of Bologna;Bologna,Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D000073602:Antimicrobial Stewardship / Q000379:methods*; D015780:Carbapenems / Q000008:administration & dosage; D003428:Cross Infection / Q000517:prevention & control*; D024841:Fluoroquinolones / Q000008:administration & dosage; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy; D012017:Referral and Consultation; D012047:Rehabilitation Centers / Q000458:organization & administration*; D013124:Spinal Injuries / Q000534:rehabilitation
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones