Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the Public Health System of Andalusia, Spain: an ecologic study of time-trend analysis

Abstract

Objectives: Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. Methods: We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. Results: The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) ¼ À3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC ¼ À0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased.

RETRACTED ARTICLE: Pharmacist-driven antimicrobial stewardship program in a long-term care facility by assessment of appropriateness

“…In Andalusia, the most populated autonomous region in Spain, with 8.4 million inhabitants, an ASP called the PIRASOA programme 17 was approved on February 2013. It was implemented in the Andalusian Public Healthcare System (SSPA) at both primary and hospital healthcare levels.…”

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“…The impact of working together as a team has been demonstrated by the Primary Immune Deficiency Treatment Consortium (PIDTC) in North America, which has supported the diagnosis and management and research in the field of PID ( 12 – 15 ). Similar results have been seen in the EBMT ( 16 – 18 ) and Latin American groups ( 19 ) with data from focused groups showing improvement in overall survival. Significant challenges in early diagnosis, supportive care and financial constraints need to be overcome in low and middle income countries as reported by groups from Brazil, Jordan, China, Iran and Turkey ( 20 – 26 ).…”

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“…We were also not able to set up, in parallel to our ASP, an educational program that could lead to improved practitioner adherence as well as antibiotics prescribing over the long term [33]. Indeed, in a recent Spanish study, the quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower over 3 years thanks to regular educational interviews [34]. In addition, we could not evaluate antibiotic prescription at the discharge because of the lack of computerization.…”