期刊
CLINICAL INFECTIOUS DISEASES
卷 73, 期 11, 页码 E4454-E4462出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/ciaa1004
关键词
antibiotic stewardship; antibiotic resistance; antibiotic consumption
资金
- National Institute of Allergy and Infectious Diseases [5R21AI128216-02]
This retrospective cohort study examined the impact of an antibiotic stewardship program (ASP) on antibiotic usage and infection rates of drug-resistant organisms in a healthcare setting. Results showed a decrease in overall antibiotic use post-ASP implementation, but an increase in vancomycin-resistant enterococci infections. The study suggests that successful reduction in antibiotic consumption through ASPs may not necessarily lead to a decrease in antibiotic-resistant infections.
Background. Antibiotic stewardship programs (ASPs) have demonstrated success at reducing costs, yet there is limited quality evidence of their effectiveness in reducing infections of high-profile drug-resistant organisms. Methods. This retrospective, cohort study included all Kaiser Permanente Southern California (KPSC) members aged >= 18 years hospitalized in 9 KPSC hospitals from 1 January 2008 to 31 December 2016. We measured the impact of staggered ASP implementation on consumption of 18 ASP-targeted antibiotics using generalized linear mixed-effects models. We used multivariable generalized linear mixed-effects models to estimate the adjusted effect of an ASP on rates of infection with drug-resistant organisms. Analyses were adjusted for confounding by time, cluster effects, and patient- and hospital-level characteristics. Results. We included 765 111 hospitalizations (288 257 pre-ASP, 476 854 post-ASP). By defined daily dose, we found a 6.1% (-7.5% to -4.7%) overall decrease antibiotic use post-ASP; by days of therapy, we detected a 4.3% (-5.4% to -3.1%) decrease in overall use of antibiotics. The number of prescriptions increased post-ASP (1.04 [1.03-1.05]). In adjusted analyses, we detected an overall increase in vancomycin-resistant enterococci infections post-ASP (1.37 [1.10-1.69]). We did not detect a change in the rates of extended-spectrum beta-lactamase, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa infections post-ASP. Conclusions. ASPs with successful reductions in consumption of targeted antibiotics may not see changes in infection rates with antibiotic-resistant organisms in the 2 to 6 years post-implementation. There are likely differing timescales for reversion to susceptibility across organisms and antibiotics, and unintended consequences from compensatory prescribing may occur.
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