Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum β-lactamase-producing Escherichia coli in the community: an interrupted time-series analysis

Peñalva, Germán; Fernández-Urrusuno, Rocío; Turmo, José María; Hernández-Soto, Rocío; Pajares, Ignacio; Carrión, Lucía; Vázquez-Cruz, Inmaculada; Botello, Blanca; García-Robredo, Beatriz; Cámara-Mestres, Manuel; Domínguez-Camacho, Juan Carlos; Aguilar-Carnerero, Manuel María; Lepe, José Antonio; Cueto, Marina de; Serrano-Martino, María Carmen; Domínguez-Jiménez, María Carmen; Domínguez-Castaño, Ana; Cisneros, José Miguel; Alcántara, Juan deDios; Álvarez‐Marín, Rocío; Cos-Vega, Ana; Delgado-Cuesta, Juan; Fajardo, José María; Garrucho-Moreno, Joaquín; Hevia, Elena; Irastorza, Aránzazu; Mestraitúa-Vázquez, Ainhoa; Molina, José Antonio; Montero, Emilio; Palma-Aguilar, José Luis; Remesal, Tomás; Retamar, Pilar; Taboada-Prieto, Salomé; Toral, Javier; Torres-Moreno, Joaquín

doi:10.1016/s1473-3099(19)30573-0

Cited by 51 publications

(59 citation statements)

References 21 publications

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“…Our results showed that an optimistic scenario with 50% restriction in antibiotic use reduced the probability of transmission modestly, by 2-6%, and that even a 10% improvement of HH compliance was more effective than a 62% reduction in antibiotic use in the community. Although antibiotic stewardship programmes may be important [27], our results show that improvement of HH was more effective in controlling the transmission of ESBL-EC in the community.…”

Section: Discussionmentioning

confidence: 65%

“…One showed that a 28% reduction in the overall use of quinolones resulted in a significant increase in the susceptibility of E. coli to quinolones [26]. Another showed that antibiotic stewardship led to reduction of ciprofloxacin and cephalosporins and decreased the incidence of infections caused by ESBL-EC in the community [27]. One other study investigated the impact of restriction of sulphonamide prescription in the UK on the prevalence of resistance in E. coli [28].…”

Section: Discussionmentioning

confidence: 99%

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Hand hygiene improvement or antibiotic restriction to control the household transmission of extended-spectrum β-lactamase-producing Escherichia coli: a mathematical modelling study

Kardaś-Słoma

Yazdanpanah

Perozziello

et al. 2020

Antimicrob Resist Infect Control

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Background: The best strategy to control ESBL-producing Escherichia coli (ESBL-EC) spread in the community is lacking. Methods: We developed an individual-based transmission model to evaluate the impact of hand hygiene (HH) improvement and reduction in antibiotic use on the within-household transmission of ESBL-EC. We used data from the literature and incorporated key elements of ESBL-EC transmission such as the frequency and nature of contacts among household members, antibiotic use in the community and hand hygiene behaviour. We introduced in a household a single ESBL-EC colonised person and simulated the transmission dynamics of ESBL-EC over a one-year time horizon. Results: The probability of ESBL-EC transmission depended on the household composition and the profile of the initial carrier. In the two-person household, the probability of ESBL-EC transmission was 5.3% (95% CI 5.0-5.6) or 6.6% (6.3-6.9) when the index person was a woman or a man, respectively. In a four-person household, the probability of transmission varied from 61.4% (60.9-62.0) to 68.8% (68.3-69.3) and was the highest when the index patient was the baby. Improving HH by 50% reduced the probability of transmission by 33-62%. Antibiotic restriction by 50% reduced the transmission by 2-6%. Conclusions: The transmission of ESBL-EC is frequent in households and especially those with a baby. Antibiotic reduction had little impact on ESBL-EC. Improvement of hygiene in the community could help prevent transmission of ESBL-EC.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Hand hygiene improvement or antibiotic restriction to control the household transmission of extended-spectrum β-lactamase-producing Escherichia coli: a mathematical modelling study

Kardaś-Słoma

Yazdanpanah

Perozziello

et al. 2020

Antimicrob Resist Infect Control

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“…Studies have reported contradictory results and pointed out several related factors about the impacts of educational intervention. Most of the studies support the e cacy of long-term antimicrobial stewardship programs [26,27].…”

Section: Discussionmentioning

confidence: 94%

Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

Hosoglu

Claßen

2020

Preprint

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Background Antibiotic consumption rates increase worldwide steadily. Turkey is now top on the list of global consumption and a prototype of excessive use of antibiotics. In the last two-decades, family physicians (FPs) have become key figures in the healthcare system. The aim of this study is to understand the reasons for inappropriate prescription and to elicit suggestions for ways of improving antibiotic use in primary care from doctors themselves.Methods This is a qualitative study using semi-structured interviews with key individuals. Fourteen FPs from different parts of Turkey participated in these interviews. They were questioned on major indications for antibiotic prescription, reasons for inappropriate antibiotic prescription, obstacles to decision making in antibiotic use and their suggestions for improving antibiotic use. The interviews were recorded, transcribed, and analyzed for common themes. Thematic coding was used in the formulation of themes.Results Interviewees emphasized the coercive factors that lead to inappropriate antibiotic prescription: patient expectations, defensive medical decision making, constraints due to workload and limited access to laboratories. The most powerful suggestions for improving the quality of antibiotic prescription were public campaigns, improvements in the diagnostic infrastructures of primary care centers and enhancing the social status of FPs. The FPs expressed strong concerns related to the complaints that patients make to administrative bodies. Conclusions Physicians in primary care work under immense pressure stemming mainly from workload, patient expectations and obstacles to diagnostic processes. Improving the social status of physicians, increasing public awareness and the facilitation of diagnostic procedures were the methods suggested for increasing antibiotic prescription accuracy.

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“…Education alone is noted to be a low-effectiveness stewardship strategy, unless it is combined with real-time intervention(s) [ 31 ]. Peñalva and colleagues evaluated the impact of structured and consistent educational efforts on rates of ESBL E. coli in Spain [ 14 ]. The study spanned from January 2012 to December 2017 (pre-intervention 2012–2013, intervention 2014–2017) and included 5 interventions (shown in Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

Stover

Chahine

Cluck

et al. 2020

Open Forum Infectious Diseases

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Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training as well as to identify potential intervention opportunities within one’s institution

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Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum β-lactamase-producing Escherichia coli in the community: an interrupted time-series analysis

Cited by 51 publications

References 21 publications

Hand hygiene improvement or antibiotic restriction to control the household transmission of extended-spectrum β-lactamase-producing Escherichia coli: a mathematical modelling study

Hand hygiene improvement or antibiotic restriction to control the household transmission of extended-spectrum β-lactamase-producing Escherichia coli: a mathematical modelling study

Antibiotic prescription in primary care from the perspective of family physicians: a qualitative study

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

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