Clinical impact of an educational antimicrobial stewardship program associated with infectious diseases consultation targeting patients with cancer: Results of a 9-year quasi-experimental study with an interrupted time-series analysis

Molina, José Antonio; Noguer, M.; Lepe, José Antonio; Pérez-Moreno, María Antonia; Aguilar‐Guisado, Manuela; Vega, Roberto Lasso de la; Peñalva, Germán; Crespo‐Rivas, Juan Carlos; Gil-Navarro, María Victoria; Salvador, J.; Cisneros, José Miguel

doi:10.1016/j.jinf.2019.07.002

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…Nonetheless, regarding the use of antimicrobials, the stable trends during the pre-intervention period suggest that the implementation of the ASP was necessary to achieve the goals. The sole IDC was insufficient to promote a change in the entire department, as reported in previous studies [26]. Finally, non-MDR BSI, invasive candidiasis (other than candidemia) and aspergillosis have not been examined in this study.…”

Section: Discussionmentioning

confidence: 86%

“…The effect on the mortality rates was assessed as the all-cause crude death rate [9,32] (deaths per 1000 OBD per quarter) on day +7 (early mortality) and +30 (late mortality) after the diagnosis of BSI. Patients dying in less than 24 h after blood sample collection were not considered for the mortality analysis, as previously proposed [26,33,34], for a better selection of patients benefitting from the intervention targeting an optimized use of antimicrobials.…”

Section: Study Measuresmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 86%

Section: Study Measuresmentioning

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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“…PRIOAM is a set of educational strategies implemented by a multidisciplinary team consisting of infectious disease, microbiology, pharmacy, intensive care, pediatrics, prevention, and nursing professionals. The results obtained by PRIOAM in the whole center and specific settings other than the EDOU have already been published [23][24][25].…”

Section: Interventionmentioning

confidence: 90%

Antimicrobial Stewardship in the Emergency Department Observation Unit: Definition of a New Indicator and Evaluation of Antimicrobial Use and Clinical Outcomes

Guisado-Gil,

Mejías-Trueba,

Peñalva

et al. 2024

Antibiotics

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We aimed to define a novel indicator for monitoring antimicrobial use specifically in the Emergency Department Observation Unit (EDOU) and to assess the long-term impact of an institutional education-based antimicrobial stewardship program (ASP) on the antimicrobial prescribing pattern and clinical outcomes in this setting. A quasi-experimental interrupted time-series study was performed from 2011 to 2022. An educational ASP was implemented at the EDOU in 2015. To estimate changes in antimicrobial use, we designed an indicator adjusted for patients at risk of antimicrobial prescribing: defined daily doses (DDDs) per 100 patients transferred from the Emergency Department to the Observation Unit (TOs) per quarter. The number of bloodstream infections (BSIs) and the crude all-cause 14-day mortality were assessed as clinical outcomes. Antimicrobial use showed a sustained reduction with a trend change of −1.17 DDD per 100 TO and a relative effect of −45.6% (CI95% −64.5 to −26.7), particularly relevant for meropenem and piperacillin-tazobactam, with relative effects of −80.4% (−115.0 to −45.7) and −67.9% (−93.9 to −41.9), respectively. The incidence density of all BSIs increased significantly during the ASP period, with a relative effect of 123.2% (41.3 to 284.7). The mortality rate remained low and stable throughout the study period, with an absolute effect of −0.7% (−16.0 to 14.7). The regular monitoring of antimicrobial use in the EDOU by using this new quantitative indicator was useful to demonstrate that an institutional education-based ASP successfully achieved a long-term reduction in overall antimicrobial use, with a low and steady BSI mortality rate.

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“…Finally, they concluded that the application of their method might support appropriate cancer management. In another study that was conducted during 2009-2017 in a cancer department in Spain, the investigators noticed that the combination of IDC and ASP benefited antibiotic use in cancer patients, and this improvement was associated with a decrease in mortality due to bacterial infections [183]. Likewise, a prospective cohort study in Brazil during 2009-2011 analyzed 307 episodes of chemotherapy-induced febrile neutropenia in 169 patients [184].…”

Section: Antimicrobial Stewardship In Cancer Patientsmentioning

confidence: 99%

An Overview of Selected Bacterial Infections in Cancer, Their Virulence Factors, and Some Aspects of Infection Management

Ray

Moore

Pandit

et al. 2023

Biology

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In cancer development and its clinical course, bacteria can be involved in etiology and secondary infection. Regarding etiology, various epidemiological studies have revealed that Helicobacter pylori can directly impact gastric carcinogenesis. The Helicobacter pylori-associated virulence factor cytotoxin-associated gene A perhaps plays an important role through different mechanisms such as aberrant DNA methylation, activation of nuclear factor kappa B, and modulation of the Wnt/β-catenin signaling pathway. Many other bacteria, including Salmonella and Pseudomonas, can also affect Wnt/β-catenin signaling. Although Helicobacter pylori is involved in both gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma, its role in the latter disease is more complicated. Among other bacterial species, Chlamydia is linked with a diverse range of diseases including cancers of different sites. The cellular organizations of Chlamydia are highly complex. Interestingly, Escherichia coli is believed to be associated with colon cancer development. Microorganisms such as Escherichia coli and Pseudomonas aeruginosa are frequently isolated from secondary infections in cancer patients. In these patients, the common sites of infection are the respiratory, gastrointestinal, and urinary tracts. There is an alarming rise in infections with multidrug-resistant bacteria and the scarcity of suitable antimicrobial agents adversely influences prognosis. Therefore, effective implementation of antimicrobial stewardship strategies is important in cancer patients.

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Clinical impact of an educational antimicrobial stewardship program associated with infectious diseases consultation targeting patients with cancer: Results of a 9-year quasi-experimental study with an interrupted time-series analysis

Cited by 4 publications

References 19 publications

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

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

Antimicrobial Stewardship in the Emergency Department Observation Unit: Definition of a New Indicator and Evaluation of Antimicrobial Use and Clinical Outcomes

An Overview of Selected Bacterial Infections in Cancer, Their Virulence Factors, and Some Aspects of Infection Management

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