Do specific antimicrobial stewardship interventions have an impact on carbapenem resistance in Gram-negative bacilli? A multicentre quasi-experimental ecological study: time-trend analysis and characterization of carbapenemases

Álvarez‐Marín, Rocío; López-Cerero, Lorena; Guerrero-Sánchez, Francisca; Palop-Borrás, Begoña; Rojo-Martín, María Dolores; Ruiz-Sancho, Andrés; Herrero‐Rodríguez, Carmen; García, María Victoria; Lazo-Torres, Ana María; López, Inmaculada; Martín-Hita, Lina; Nuño-Álvarez, Enrique; Sánchez-Yebra, Waldo; Galán-Sánchez, Fátima; Reguera-Iglesias, José María; Lepe, José Antonio Suárez; Peñalva, Germán; Pascual, Álvaro; Cisneros, José Miguel; team, CarbaPIRASOA

doi:10.1093/jac/dkab073

Cited by 16 publications

(8 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mathematical models have described the potential impact of reducing carbapenem consumption on resistance acquisition among bacteria, including CRAb [ 66 ], and antimicrobial stewardship to restrict carbapenem usage has been suggested for controlling outbreaks caused by CRAb in critical care settings [ 67 , 68 , 69 ]. There is an abundance of reports and studies on the effectiveness of infection control measures in limiting the transmission of CRAb in hospital ICUs.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

Rizk

Zahreddine²,

Haddad³

et al. 2022

Antibiotics

View full text Add to dashboard Cite

Antimicrobial resistance is a serious threat to global health, causing increased mortality and morbidity especially among critically ill patients. This toll is expected to rise following the COVID-19 pandemic. Carbapenem-resistant Acinetobacter baumannii (CRAb) is among the Gram-negative pathogens leading antimicrobial resistance globally; it is listed as a critical priority pathogen by the WHO and is implicated in hospital-acquired infections and outbreaks, particularly in critically ill patients. Recent reports from Lebanon describe increasing rates of infection with CRAb, hence the need to develop concerted interventions to control its spread. We set to describe the impact of combining antimicrobial stewardship and infection control measures on resistance rates and colonization pressure of CRAb in the intensive care units of a tertiary care center in Lebanon before the COVID-19 pandemic. The antimicrobial stewardship program introduced a carbapenem-sparing initiative in April 2019. During the same period, infection control interventions involved focused screening, monitoring, and tracking of CRAb, as well as compliance with specific measures. From January 2018 to January 2020, we report a statistically significant decrease in carbapenem consumption and a decrease in resistance rates of isolated A. baumannii. The colonization pressure of CRAb also decreased significantly, reaching record low levels at the end of the intervention period. The results indicate that a multidisciplinary approach and combined interventions between the stewardship and infection control teams can lead to a sustained reduction in resistance rates and CRAb spread in ICUs.

show abstract

Section: Discussionmentioning

confidence: 99%

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

Rizk

Zahreddine²,

Haddad³

et al. 2022

Antibiotics

View full text Add to dashboard Cite

show abstract

“…Nonetheless, our results agree with previous studies pointing to the ecologic relevance of antimicrobial stewardship. 1,5,29 Our study had several limitations, mostly due to the observational, retrospective, and the partially ecologic approaches. 2,20 We did not directly address interventions on antimicrobial prescription formularies.…”

Section: Discussionmentioning

confidence: 99%

Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

Oliveira

Sampaio

Leite

et al. 2022

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Objective: To measure the impact of exposure to patients using carbapenem on the acquisition of carbapenem-resistant gram-negative bacilli (CR-GNB) among patients not using carbapenems. Design: An ecological study and a cohort study. Setting: Two medical surgical intensive care units (ICUs) in inner Brazil. Participants: Patients admitted to 2 ICUs from 2013 through 2018 to whom carbapenem was not prescribed. Methods: In the ecologic study, the monthly use of carbapenems (days of therapy [DOT] per 1,000 patient days) was tested for linear correlation with the 2-month moving average of incidence CR-GNB among patients to whom carbapenem was not prescribed. In the cohort study, those patients were addressed individually for risk factors (demographics, invasive interventions, use of antimicrobials) for acquisition of CR-GNB, including time at risk and the “carbapenem pressure,” described as the aggregate DOT among other ICU patients during time at risk. The analysis was performed in univariate and multivariable Poisson regression models. Results: The linear regression model revealed an association of total carbapenem use and incidence of CR-GNB (coefficient, 0.04; 95% confidence interval [CI], 0.02–0.06; P = .001). In the cohort model, the adjusted rate ratio (RR) for carbapenem DOT was 1.009 (95% CI, 1.001–1.018; P = .03). Other significant risk factors were mechanical ventilation and the previous use of ceftazidime (with or without avibactam). Conclusions: Every additional DOT of total carbapenem use increased the risk of CR-GNB acquisition by patients not using carbapenems by nearly 1%. We found evidence for a population (“herd effect”-like) impact of antimicrobial use in the ICUs.

show abstract

“…Selective pressure is a well-known risk factor for nosocomial antibiotic resistance development in Kp [ 29 ]. The role of antimicrobial stewardship in reducing the burden of multidrug resistant bacteria has been highlighted [ 30 , 31 ]. Thus, antimicrobial stewardship efforts seem to be necessary in addition to other infection control measures (e.g., screening, isolation, hand hygiene, surface disinfection).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and infection control of carbapenem resistant Acinetobacter baumannii and Klebsiella pneumoniae at a German university hospital: a retrospective study of 5 years (2015–2019)

et al. 2021

View full text Add to dashboard Cite

Background Carbapenem resistant (CR) Klebsiella pneumoniae (Kp) and Acinetobacter baumannii (Ab) are emerging multidrug resistant bacteria with very limited treatment options in case of infection. Both are well-known causes of nosocomial infections and outbreaks in healthcare facilities. Methods A retrospective study was conducted to investigate the epidemiology of inpatients with CR Kp and CR Ab in a 1500-bed German university hospital from 2015 to 2019. We present our infection control concept including a weekly microbiologic screening for patients who shared the ward with a CR Kp or CR Ab index patient. Results Within 5 years, 141 CR Kp and 60 CR Ab cases were hospitalized corresponding to 118 unique patients (74 patients with CR Kp, 39 patients with CR Ab and 5 patients with both CR Ab and CR Kp). The mean incidence was 0.045 (CR Kp) and 0.019 (CR Ab) per 100 inpatient cases, respectively. Nosocomial acquisition occurred in 53 cases (37.6%) of the CR Kp group and in 12 cases (20.0%) of the CR Ab group. Clinical infection occurred in 24 cases (17.0%) of the CR Kp group and in 21 cases (35.0%) of the CR Ab group. 14 cases (9.9%) of the CR Kp group and 29 cases (48.3%) of the CR Ab group had a history of a hospital stay abroad within 12 months prior to admission to our hospital. The weekly microbiologic screening revealed 4 CR Kp cases caused by nosocomial transmission that would have been missed without repetitive screening. Conclusions CR Kp and CR Ab cases occurred infrequently. A history of a hospital stay abroad, particularly in the CR Ab group, warrants pre-emptive infection control measures. The weekly microbiologic screening needs further evaluation in terms of its efficiency.

show abstract

Do specific antimicrobial stewardship interventions have an impact on carbapenem resistance in Gram-negative bacilli? A multicentre quasi-experimental ecological study: time-trend analysis and characterization of carbapenemases

Cited by 16 publications

References 22 publications

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

Epidemiology and infection control of carbapenem resistant Acinetobacter baumannii and Klebsiella pneumoniae at a German university hospital: a retrospective study of 5 years (2015–2019)

Contact Info

Product

Resources

About