Impact of an antimicrobial stewardship program indicator on the appropriateness of the empiric antibiotic treatment of urinary source Escherichia coli bacteraemia
Por:
Giménez-Pérez, M, Hernández, S, Padullés, A, Boix-Palop, L, Grau, S, Badia, JM, Ferrer, R, Calbo, E, Limón, E, Pujol, M and Horcajada, JP
Publicada:
1 ago 2024
Ahead of Print:
1 jun 2024
Resumen:
A prospective multicentre study was carried out between 2017 and 2021 to assess (1) the appropriateness of the empirical treatment to the local guidelines of urinary source Escherichia coli bacteraemia, (2) the appropriateness of empirical treatment to antibiotic sensitivity results and (3) the degree of error in the local guidelines regarding the antibiotic sensitivity reported in acute care hospitals enrolled in the vigil & aacute;ncia de les infeccions relacionades amb l'atenci & oacute; sanit & aacute;ria de Catalunya program. During the study period, 79.0% of the empirical treatments analysed complied with the guidelines and 88.1% were appropriate in view of the in vitro activity of the isolated strain. The rate of appropriateness rose from 73.8% in 2017 to 81.0% in 2021 ( P < 0.001). The degree of error in the recommendations regarding the in vitro activity of the isolated strains was 5.9% and remained stable during the study period. Antibiotic families correctly prescribed according to the guidelines were third -generation cephalosporins (54.9%), carbapenems (16.8%) and combinations of penicillins and beta-lactamase inhibitors (16.4%). Of the 8009 E. coli strains, 19.0% were extended -spectrum beta-lactamases producers, 36.8% were resistant to quinolones and 0.5% were resistant to carbapenems. The broad implementation of an antimicrobial stewardship program with quality indicators of antibiotic use improved compliance to local guidelines in the empiric treatment of urinary tract E. coli bacteraemia. The degree of error in local guidelines was low but higher in more complex hospitals and in healthcare -associated infections. Guidelines need to be constantly updated with the use of epidemiological data, rapid diagnostic tests and the analysis of patient risk factors specific to each geographical area. (c) 2024 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Filiaciones:
:
Hosp Univ Germans Trias i Pujol, Microbiol Dept, Lab Clin Metropolitana Nord, CIBERES, Carreterade Canyet S-N, Badalona 08916, Spain
Hernández, S:
VINCat Programme Surveillance Healthcare Related I, Dept Salut, Serv Catala Salut, Barcelona, Spain
Padullés, A:
Univ Barcelona, Hosp Univ Bellvitge, Pharm Dept, IDIBELL, Barcelona, Spain
Inst Carlos III, Ctr Invest Biomed Red Enfermedades Infecciosas CIB, Madrid, Spain
Boix-Palop, L:
Hosp Univ Mutua Terrassa, Infect Dis Serv, Barcelona, Spain
Univ Int Catalunya, Med Dept, Barcelona, Spain
Grau, S:
Inst Hosp Mar Invest Med IMIM, Hosp Mar, Ctr Invest Biomed Red Enfermedades Infecciosas CIB, Pharm Dept Infect Dis Serv,Infect Pathol & Antimic, Barcelona, Spain
Badia, JM:
Univ Int Catalunya, Hosp Gen Granollers, Dept Surg, Barcelona, Spain
Ferrer, R:
Hosp Univ Vall Hebron, Vall Hebron Inst Res, Intens Care Dept, Barcelona, Spain
Calbo, E:
Hosp Univ Mutua Terrassa, Infect Dis Serv, Barcelona, Spain
Univ Int Catalunya, Med Dept, Barcelona, Spain
Limón, E:
VINCat Programme Surveillance Healthcare Related I, Dept Salut, Serv Catala Salut, Barcelona, Spain
Inst Carlos III, Ctr Invest Biomed Red Enfermedades Infecciosas CIB, Madrid, Spain
Univ Barcelona, Fac Nursing, Dept Publ Hlth Mental Hlth & Mother Infant Nursing, Barcelona, Spain
Pujol, M:
VINCat Programme Surveillance Healthcare Related I, Dept Salut, Serv Catala Salut, Barcelona, Spain
Inst Carlos III, Ctr Invest Biomed Red Enfermedades Infecciosas CIB, Madrid, Spain
Hosp Univ Bellvitge, Dept Infect Dis, IDIBELL, Hosp Llobregat, Madrid, Spain
Horcajada, JP:
Inst Carlos III, Ctr Invest Biomed Red Enfermedades Infecciosas CIB, Madrid, Spain
Univ Pompeu Fabra UPF, Hosp Mar, Hosp Mar Res Inst IMIM, Infect Dis Serv, Barcelona, Spain
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