Antimicrobial Stewardship in a Gastroenterology Department: Impact on Antimicrobial Consumption, Antimicrobial Resistance and Clinical Outcome

Andrea Brasacchio

Background: A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials.
Aims: To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program (ASP) in an Italian Gastroenterology Department.
Methods: Between October 2014 and September 2015 (period B), an infectious disease (ID) specialist controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of multidrug (MDR)-infections, mean length of stay, and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A).
Results: During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decrease of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p = 0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p = 0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p = 0.0032), and quinolones (from 35.79 to 17.82 DDDsx100pd, p = 0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate.
Conclusions: ASP had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality.

Simone Agnello
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