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Peñalva G, Crespo-Rivas JC, Guisado-Gil AB, Rodríguez-Villodres Á, Pachón-Ibáñez ME, Cachero-Alba B, Rivas-Romero B, Gil-Moreno J, Galvá-Borras MI, García-Moreno M, Salamanca-Bautista MD, Martínez-Rascón MB, Cantudo-Cuenca MR, Ninahuaman-Poma RC, Enrique-Mirón MDLÁ, Pérez-Barroso A, Marín-Ariza I, González-Florido M, Mora-Santiago MDR, Belda-Rustarazo S, Expósito-Tirado JA, Rosso-Fernández CM, Gil-Navarro MV, Lepe-Jiménez JA, Cisneros JM. Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis. Clin Infect Dis 2023; 76:824-832. [PMID: 36268822 PMCID: PMC9619844 DOI: 10.1093/cid/ciac834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs. METHODS We performed a cluster, randomized, controlled trial and a before-after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD). RESULTS The total mean antimicrobial consumption decreased by 31.2% (-16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin-clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (-14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P < .0001). CONCLUSIONS This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic. Clinical Trials Registration. NCT03543605.
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Affiliation(s)
- Germán Peñalva
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Juan Carlos Crespo-Rivas
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - Ana Belén Guisado-Gil
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain.,Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain.,CIBERINFECT, Center for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - Ángel Rodríguez-Villodres
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain
| | - María Eugenia Pachón-Ibáñez
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain.,CIBERINFECT, Center for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - María Victoria Gil-Navarro
- Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain.,CIBERINFECT, Center for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - José Antonio Lepe-Jiménez
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain.,CIBERINFECT, Center for Biomedical Research Network on Infectious Diseases, Madrid, Spain
| | - José Miguel Cisneros
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain.,CIBERINFECT, Center for Biomedical Research Network on Infectious Diseases, Madrid, Spain
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