Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH

Rodríguez-Baño, Jesús; Paño‐Pardo, José Ramón; Álvarez–Rocha, Luis; Asensio, Ángel; Calbo, Esther; Cercenado, Emilia; Cisneros, José Miguel; Cobo, Javier; Delgado, Olga; Garnacho-Montero, José; Grau, Santiago; Horcajada, Juan Pablo; Hornero, Ana; Murillas-Angoiti, Javier; Oliver, Antonio; Padilla, Belén; Pasquau, Juan; Pujol, Miquel; Ruíz-Garbajosa, Patricia; Juan, Rafael San; Sierra, Rafael J.

doi:10.1016/j.eimc.2011.09.018

Cited by 148 publications

(71 citation statements)

References 146 publications

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“…Stewardship programs are extensively used in the United States and compliance with the various recommendations is monitored annually by the National Healthcare Safety Network Annual Hospital Survey (3,4). In Spain, different scientific societies promoted the development of a consensus document for optimizing the use of antimicrobials in hospitals (PROA project) (5).…”

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confidence: 99%

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

Álvarez-Lerma

Grau

Echeverría-Esnal

et al. 2018

Antimicrob Agents Chemother

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We evaluated the use of antimicrobials expressed as defined daily doses (DDDs) per 1,000 patient days and days of therapy (DOT) per 100 occupied bed-days in a intensive care unit (ICU) of a general hospital in Barcelona, Spain, before and after implementation of an antimicrobial stewardship (AMS) program (2007 to 2010 versus 2011 to 2015). The quarterly costs of antimicrobials used in the ICU and its weight in the overall hospital costs of antimicrobials were calculated. The effect of the applied AMS program on DDDs and DOT time series data was analyzed by means of intervention time series analysis. A total of 5,002 patients were included (1,971 for the first [before] period and 3,031 for the second [after] period). The percentage of patients treated with one or more antimicrobials decreased from 88.6 to 77.2% ( < 0.001). DDDs decreased from 246.8 to 192.3 (mean difference, -54.5; = 0.001) and DOT from 66.7 to 54.6 (mean difference, -12.1; = 0.066). The mean cost per trimester decreased from €115,543 to €73,477 (mean difference, -42,065.4 euros; < 0.001), and the percentage of ICU antimicrobials cost with respect to the total cost of hospital antimicrobials decreased from 28.5 to 22.8% (mean difference, -5.59; = 0.023). Implementation of an AMS program in the ICU was associated with a marked reduction in the use of antimicrobials, with cost savings close to one million euros since its implementation. An AMS program can have a significant impact on optimizing antimicrobial use in critical care practice.

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confidence: 99%

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

Álvarez-Lerma

Grau

Echeverría-Esnal

et al. 2018

Antimicrob Agents Chemother

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“…However, experts did recognize the problems caused by the overuse of these drugs in Spain, and the need to strength programs developed at the national level in order to optimize their use and reduce antimicrobial resistance [84,85]. Another drug class that was not included on the HAMC list comprises those medications that interfere with the renin-angiotensin system, even though the available evidence shows that they are associated with a high percentage of adverse events that lead to hospitalization, because the experts felt that their use was extremely frequent use in chronic patients and assigned them low priority for inclusion.…”

Section: Discussionmentioning

confidence: 99%

Developing a list of high-alert medications for patients with chronic diseases

Otero

Moreno-Gómez²,

Santos-Ramos³

et al. 2014

European Journal of Internal Medicine

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“…Hence, therapeutic treatment is frequently not adapted to the microbial epidemiology of the specific healthcare area, which may favor therapeutic failure. Numerous publications by scientific societies and healthcare institutions have emphasized the need to consider local epidemiology in the development of therapeutic guidelines for the prescription of empiric antibiotics [15–17, 21, 22]. …”

Section: Discussionmentioning

confidence: 99%

“…They have proven effective to improve medical care, reduce prescription errors, and enhance compliance with recommendations [28, 29]. These programs do not replace clinical judgment but rather increase the information available for physicians to be able to make correct decisions [22]. A systematic review associated successful CDSS implementation with the integration of the system in the clinical process and with the availability of recommendations at the time and place of decision making [30].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, besides the identification and study of microorganism susceptibility, the microbiology laboratory has a role in periodically updating results for designing empiric antibiotic treatment guidelines adapted to the local microbial epidemiology [21, 22]. These guidelines should be based on the best available clinical evidence and on the resistance profiles in each healthcare setting [6, 18].…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a Computerized Decision Support System to Improve the Appropriateness of Antibiotic Therapy Using Local Microbiologic Data

Rodríguez-Maresca

Sorlózano

Grau

et al. 2014

BioMed Research International

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A prospective quasi-experimental study was undertaken in 218 patients with suspicion of nosocomial infection hospitalized in a polyvalent ICU where a new electronic device (GERB) has been designed for antibiotic prescriptions. Two GERB-based applications were developed to provide local resistance maps (LRMs) and preliminary microbiological reports with therapeutic recommendation (PMRTRs). Both applications used the data in the Laboratory Information System of the Microbiology Department to report on the optimal empiric therapeutic option, based on the most likely susceptibility profile of the microorganisms potentially responsible for infection in patients and taking into account the local epidemiology of the hospital department/unit. LRMs were used for antibiotic prescription in 20.2% of the patients and PMRTRs in 78.2%, and active antibiotics against the finally identified bacteria were prescribed in 80.0% of the former group and 82.4% of the latter. When neither LMRs nor PMRTRs were considered for empiric treatment prescription, only around 40% of the antibiotics prescribed were active. Hence, the percentage appropriateness of the empiric antibiotic treatments was significantly higher when LRM or PMRTR guidelines were followed rather than other criteria. LRMs and PMRTRs applications are dynamic, highly accessible, and readily interpreted instruments that contribute to the appropriateness of empiric antibiotic treatments.

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Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH

Cited by 148 publications

References 146 publications

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

Developing a list of high-alert medications for patients with chronic diseases

Implementation of a Computerized Decision Support System to Improve the Appropriateness of Antibiotic Therapy Using Local Microbiologic Data

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