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Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs

Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients’ safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatment...

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Autores principales: Mandelli, Giulia, Dore, Francesca, Langer, Martin, Garbero, Elena, Alagna, Laura, Bianchin, Andrea, Ciceri, Rita, Di Paolo, Antonello, Giani, Tommaso, Giugni, Aimone, Gori, Andrea, Lefons, Ugo, Muscatello, Antonio, Olivieri, Carlo, Pan, Angelo, Pedeferri, Matteo, Rossi, Marianna, Rossolini, Gian Maria, Russo, Emanuele, Silengo, Daniela, Viaggi, Bruno, Bertolini, Guido, Finazzi, Stefano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369193/
https://www.ncbi.nlm.nih.gov/pubmed/35956026
http://dx.doi.org/10.3390/jcm11154409
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author Mandelli, Giulia
Dore, Francesca
Langer, Martin
Garbero, Elena
Alagna, Laura
Bianchin, Andrea
Ciceri, Rita
Di Paolo, Antonello
Giani, Tommaso
Giugni, Aimone
Gori, Andrea
Lefons, Ugo
Muscatello, Antonio
Olivieri, Carlo
Pan, Angelo
Pedeferri, Matteo
Rossi, Marianna
Rossolini, Gian Maria
Russo, Emanuele
Silengo, Daniela
Viaggi, Bruno
Bertolini, Guido
Finazzi, Stefano
author_facet Mandelli, Giulia
Dore, Francesca
Langer, Martin
Garbero, Elena
Alagna, Laura
Bianchin, Andrea
Ciceri, Rita
Di Paolo, Antonello
Giani, Tommaso
Giugni, Aimone
Gori, Andrea
Lefons, Ugo
Muscatello, Antonio
Olivieri, Carlo
Pan, Angelo
Pedeferri, Matteo
Rossi, Marianna
Rossolini, Gian Maria
Russo, Emanuele
Silengo, Daniela
Viaggi, Bruno
Bertolini, Guido
Finazzi, Stefano
author_sort Mandelli, Giulia
collection PubMed
description Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients’ safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatments in antibiotic stewardship programs. We conducted a multicenter pre-post study to assess the impact of a stewardship program in seven Italian intensive care units (ICUs). Each ICU was visited by a multidisciplinary team involving clinicians, microbiologists, pharmacologists, infectious disease specialists, and data scientists. Interventions were targeted according to the characteristics of each unit. The effect of the program was measured with a panel of indicators computed with data from the MargheritaTre electronic health record. The median duration of empirical therapy decreased from 5.6 to 4.6 days and the use of quinolones dropped from 15.3% to 6%, both p < 0.001. The proportion of multi-drug-resistant bacteria (MDR) in ICU-acquired infections fell from 57.7% to 48.8%. ICU mortality and length of stay remained unchanged, indicating that reducing antibiotic administration did not harm patients’ safety. This study shows that our stewardship program successfully improved the management of infections. This suggests that policy makers should tackle multidrug resistance with a multidisciplinary approach based on continuous monitoring and personalised interventions.
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spelling pubmed-93691932022-08-12 Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs Mandelli, Giulia Dore, Francesca Langer, Martin Garbero, Elena Alagna, Laura Bianchin, Andrea Ciceri, Rita Di Paolo, Antonello Giani, Tommaso Giugni, Aimone Gori, Andrea Lefons, Ugo Muscatello, Antonio Olivieri, Carlo Pan, Angelo Pedeferri, Matteo Rossi, Marianna Rossolini, Gian Maria Russo, Emanuele Silengo, Daniela Viaggi, Bruno Bertolini, Guido Finazzi, Stefano J Clin Med Article Multidrug resistance has become a serious threat for health, particularly in hospital-acquired infections. To improve patients’ safety and outcomes while maintaining the efficacy of antimicrobials, complex interventions are needed involving infection control and appropriate pharmacological treatments in antibiotic stewardship programs. We conducted a multicenter pre-post study to assess the impact of a stewardship program in seven Italian intensive care units (ICUs). Each ICU was visited by a multidisciplinary team involving clinicians, microbiologists, pharmacologists, infectious disease specialists, and data scientists. Interventions were targeted according to the characteristics of each unit. The effect of the program was measured with a panel of indicators computed with data from the MargheritaTre electronic health record. The median duration of empirical therapy decreased from 5.6 to 4.6 days and the use of quinolones dropped from 15.3% to 6%, both p < 0.001. The proportion of multi-drug-resistant bacteria (MDR) in ICU-acquired infections fell from 57.7% to 48.8%. ICU mortality and length of stay remained unchanged, indicating that reducing antibiotic administration did not harm patients’ safety. This study shows that our stewardship program successfully improved the management of infections. This suggests that policy makers should tackle multidrug resistance with a multidisciplinary approach based on continuous monitoring and personalised interventions. MDPI 2022-07-28 /pmc/articles/PMC9369193/ /pubmed/35956026 http://dx.doi.org/10.3390/jcm11154409 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Mandelli, Giulia
Dore, Francesca
Langer, Martin
Garbero, Elena
Alagna, Laura
Bianchin, Andrea
Ciceri, Rita
Di Paolo, Antonello
Giani, Tommaso
Giugni, Aimone
Gori, Andrea
Lefons, Ugo
Muscatello, Antonio
Olivieri, Carlo
Pan, Angelo
Pedeferri, Matteo
Rossi, Marianna
Rossolini, Gian Maria
Russo, Emanuele
Silengo, Daniela
Viaggi, Bruno
Bertolini, Guido
Finazzi, Stefano
Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs
title Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs
title_full Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs
title_fullStr Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs
title_full_unstemmed Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs
title_short Effectiveness of a Multifaced Antibiotic Stewardship Program: A Pre-Post Study in Seven Italian ICUs
title_sort effectiveness of a multifaced antibiotic stewardship program: a pre-post study in seven italian icus
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369193/
https://www.ncbi.nlm.nih.gov/pubmed/35956026
http://dx.doi.org/10.3390/jcm11154409
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