Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

Mardani, Masoud; Abolghasemi, Sara; Shabani, Shiva

doi:10.1186/s13104-020-05085-3

Cited by 11 publications

(6 citation statements)

References 27 publications

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“… ↓Antibiotic procurement costs:22.3% to12.1%. ↓Resistance rates f : 30.8% to 22.3% ↓MRSA incidence: 54.4% to 34.4% Mardani et al (2020) 162 Iran Tertiary teaching hospitals. An interventional quasi-experimental study.…”

Section: Asp – Monitoring and Evaluationmentioning

confidence: 99%

Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

Majumder¹,

Rahman²,

Cohall³

et al. 2020

IDR

309

188

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Section: Asp – Monitoring and Evaluationmentioning

confidence: 99%

Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

Majumder¹,

Rahman²,

Cohall³

et al. 2020

IDR

309

188

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“…To assess the impact of ASP interventions, 24 studies (45%, 24/53) assessed clinical or patient-centered outcomes [ 62 – 64 , 66 , 67 , 69 , 73 – 75 , 77 , 79 – 81 , 86 – 88 , 97 , 100 – 104 , 106 – 108 ]. Metrics used to evaluate the intervention included length of stay in hospital (LOS) in specific units (e.g., ICU) [ 46 , 62 , 68 , 69 , 73 , 74 , 76 , 77 , 81 , 86 , 88 , 96 , 101 – 103 ], hospital mortality [ 62 , 76 , 77 , 80 , 86 , 100 – 102 , 106 ], rehospitalization [ 77 , 81 , 83 , 86 , 104 ], hospital-acquired infections [ 63 , 64 , 67 , 81 , 97 , 107 , 109 ], and device-associated infections [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

“…Microbiological outcomes to assess the impact of ASP were reported in 42% (22/53) of studies [ 63 , 65 , 66 , 71 , 76 , 79 , 81 – 85 , 87 – 89 , 100 , 101 , 109 , 110 ], including a decrease in the prevalence of multi-drug resistance bacterial strains like Acinetobacter spp , Methicillin-Resistant Staphylococcus aureus (MRSA) , Vancomycin-Resistant Enterococcus [VRE], increase in the antibiotic susceptibility of bacterial strains such as Pseudomonas aeruginosa, E. coli [ 71 , 81 , 82 , 85 ]. Studies also documented a reduction in the incidence of bacterial infections such as Clostridioides difficile infections and Candidemia [ 75 , 77 ], and a decrease in pan-drug resistant isolates [ 65 , 71 , 77 , 85 ]. Economic outcomes were assessed in 17 studies [ 39 , 65 , 69 , 71 , 81 , 86 , 88 – 90 , 93 , 94 , 96 , 100 , 103 , 104 , 107 , 110 ], and reported a decrease in hospital antibiotic procurement cost [ 65 , 71 , 81 , 90 , 93 , 94 ], savings in antibiotic costs [ 39 , 69 , 86 , 88 , 104 , 110 ], decrease in antibiotic therapy and antibiotic prophylaxis cost [ 67 , 107 ], and hospitalization costs [ 110 ].…”

Section: Resultsmentioning

confidence: 99%

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

Harun,

Sumon,

Hasan

et al. 2024

Antimicrob Resist Infect Control

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Background Antimicrobial stewardship programs (ASPs) are pivotal components of the World Health Organization's Global Action Plan to combat antimicrobial resistance (AMR). ASPs advocate rational antibiotic usage to enhance patient-centered outcomes. However, existing evidence on ASPs and their determinants is largely limited to well-equipped hospitals in high-income nations. Objective This scoping review aimed to examine the current state of hospital-based ASPs in low- and middle-income countries (LMICs), shedding light on barriers, facilitators, prescribers’ perceptions and practices, and the impact of ASP interventions. Design Scoping review on ASP. Methods Adhering to PRISMA guidelines, we conducted electronic database searches on PubMed, Scopus, and Google Scholar, covering ASP articles published between January 2015 and October 2023. Our review focused on four key domains: barriers to ASP implementation, facilitators for establishing ASP, ASP perceptions and practices of prescribers, and the impact of ASP interventions. Three reviewers separately retrieved relevant data from the included citations using EndNote 21.0. Results Among the 7016 articles searched, 84 met the inclusion criteria, representing 34 LMICs. Notably, 58% (49/84) of these studies were published after 2020. Barriers to ASP implementation, including human-resources shortage, lack of microbiology laboratory support, absence of leadership, and limited governmental support, were reported by 26% (22/84) of the studies. Facilitators for hospital ASP implementation identified in five publications included the availability of antibiotic guidelines, ASP protocol, dedicated multidisciplinary ASP committee, and prompt laboratory support. The majority of the research (63%, 53/84) explored the impacts of ASP intervention on clinical, microbiological, and economic aspects. Key outcomes included increased antibiotic prescription appropriateness, reduced antimicrobial consumption, shorter hospital stays, decreased mortality rate, and reduced antibiotic therapy cost. Conclusions The published data underscores the imperative need for widespread antimicrobial stewardship in LMIC hospital settings. Substantial ASP success can be achieved through increasing human resources, context-specific interventions, the development of accessible antibiotic usage guidelines, and heightened awareness via training and education.

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“…In contrast to our results, the intervention was associated with a significant decrease in antibiotic use (−35.1 DDD per 100 patient-days), but no significant trend in antifungal prescription was observed during a two-year period (−4.0 DDD per 100 patient-days). Two other research works with a one-year evaluation time and including solid and hematological malignancy patients showed favorable results after the beginning of antimicrobial stewardship strategies in terms of global antibiotic consumption [ 11 ] and meropenem prescription [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…In hematological patients receiving immunosuppressive therapy, collateral damages of antimicrobial consumption, especially broad-spectrum antibiotic therapy, include the selection of multidrug-resistant (MDR) microorganisms [ 2 ], an increased propensity to fungal infections [ 3 ], and microbiota dysbiosis [ 4 ]. Although, due to these reasons the impact of ASPs in patients with hematological diseases might be especially relevant, information regarding the development of antimicrobial stewardship strategies in these patients is scarce [ 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Management of Patients with Hematological Diseases

et al. 2021

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Antimicrobial stewardship programs (ASPs) in hematological patients are especially relevant. However, information about ASPs in this population is scarce. For 11 years, we quarterly assessed antimicrobial consumption and incidence and death rates of multidrug-resistant (MDR) bloodstream infections (BSI) in the hematology Department. Healthcare activity indicators were also monitored yearly. We performed an interrupted time-series analysis. Antimicrobials showed a sustained reduction with a relative effect of −62.3% (95% CI −84.5 to −40.1) nine years after the inception of the ASP, being especially relevant for antifungals (relative effect −80.4%, −90.9 to −69.9), quinolones (relative effect −85.0%, −102.0 to −68.1), and carbapenems (relative effect −68.8%, −126.0 to −10.6). Incidence density of MDR BSI remained low and stable (mean 1.10 vs. 0.82 episodes per 1000 occupied bed days for the pre-intervention and the ASP period, respectively) with a quarterly percentage of change of −0.3% (95% CI −2.0 to 1.4). Early and late mortality of MDR BSI presented a steady trend (quarterly percentage of change −0.7%, 95% CI −1.7 to 0.3 and −0.6%, 95% CI −1.5 to 0.3, respectively). Volume and complexity of healthcare activity increased over the years. The ASP effectively achieved long-term reductions in antimicrobial consumption and improvements in the prescription profile, without increasing the mortality of MDR BSI.

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Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

Cited by 11 publications

References 27 publications

Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

Long-Term Impact of an Educational Antimicrobial Stewardship Program on Management of Patients with Hematological Diseases

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