Long-term positive effect of an educational antimicrobial stewardship program implemented in an Internal Medicine Department: a prospective analysis and a point prevalence survey on long-term effect

Abstract

The study aims to evaluate antimicrobial consumption and appropriateness one year after the implementation of an antimicrobial stewardship (AMS) program in an Internal Medicine Department in Milan. AMS program structured in two phases: “AMS phase”, 5 months AMS-program based on an “audit-and-feedback model”; the “follow-up phase”, 5 months long point prevalence survey conducted one year later. Outcomes of the study: antimicrobial consumption and appropriateness of antimicrobial therapy. Secondary outcomes: in-hospital mortality and length of stay (LOS). During the “AMS phase”, we obtained a mean decrease of −11.4% of total antibiotic consumption as compared to the previous year (67.9 defined daily dose (DDD)/100 bed-days (bd) vs. 79.4 DDD/100bd, p = 0.07). Antibiotic consumption remained stable during “follow-up phase” (66.3 DDD/100bd, p = 0.9). Rate of appropriateness during the project increased from 48% to 85% (p < 0.01). No difference in in-hospital mortality and in LOS were observed. The study documents a positive long-term effect of AMS program on consumption and appropriate use of antibiotics.

Keywords:

• Antimicrobial stewardship
• antibiotic consumption
• antimicrobial resistance
• appropriateness of antimicrobial therapy
• infectious diseases consultation
• multidrug-resistant bacteria

Acknowledgements

The authors wish to thank the patient who participated to the study and the staff of the Clinic of Infectious Diseases and Tropical Medicine at ASST Santi Paolo e Carlo.

Authorship

All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work and have given their approval for this version to be published.

Authors’ information

AD is a MD and a PhD student. NI, LD and OV are MDs and PhDs. TB and CA are MDs. GCM and ADM are senior professors in Infectious Diseases at the University of Milan.

Compliance with ethics guidelines

This prospective observational analysis received approval by our local Ethics committee with number of protocol: 57183/2018 in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained for enrolled patients.

Disclosure statement

The authors declare no conflict of interest.

Data availability statement

The dataset used and analyzed during the current study is available from the corresponding author on reasonable request.

Additional information

Notes on contributors

Andrea Cona

Andrea Cona, infectious diseases specialist, PhD student at the University of Milan; main field of interest and research: antimicrobial stewardship and infection control, antimicrobial resistance, nosocomial infections.

Nathalie Iannotti

Nathalie Iannotti, PhD, infectious diseases specialist; main field of research: HIV infection, antiretroviral therapy and comorbidities.

Lidia Gazzola

Lidia Gazzola, PhD, infectious diseases specialist, expert in biostatistics; main field of interest and research: HIV infection, bacterial infections

Chiara Aldieri

Chiara Aldieri, infectious diseases specialist; main field of interest and research: antimicrobial resistance, bacterial and fungal infections.

Ottavia Viganò

Ottavia Viganò, PhD, infectious diseases specialist; main field of interest and research: bacterial infections, antimicrobial resistance and tuberculosis.

Teresa Bini

Teresa Bini, infectious diseases specialist; main field of research: bacterial infection, HIV infection and antiretroviral therapy.

Giulia Marchetti

Giulia Marchetti, Associate Professor at University of Milan, infectious diseases specialist; main field of research: immune pathogenesis of HIV and other bacterial and viral infections.

Antonella d’Arminio Monforte

Antonella d'Arminio Monforte, Professor at University of Milan, Head of the Clinic of Infectious and Tropical Diseases, ASST Santi Paolo Carlo, Milan; main field of research: HIV infection and antiretroviral therapy, bacterial infections, antimicrobial resistance.