Long-Term Clinical and Ecological Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem-Resistant Klebsiella pneumoniae Infections in a High-Endemic Hospital
Abstract
:1. Introduction
2. Results
2.1. Antimicrobial Consumption
2.2. Clinical Outcomes
2.3. Potential Changes in Healthcare during the Study Period
3. Discussion
4. Materials and Methods
4.1. Study Design
4.2. Setting
4.3. Intervention
4.4. Study Measures
4.5. Microbiological Studies
4.6. Data Analysis
4.7. Ethics Approval
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Outcomes | Regression Intercept | Pre-Intervention Trend | Change in Level a | Change in Trend b | Absolute Effect c | Relative Effect (%) c |
---|---|---|---|---|---|---|
Total antibiotics (ATC-J01) | 659.3 | 0.667 (−2.642, 3.976) | −30.009 (−78.72, 18.70) | −0.663 (−4.175, 2.849) | −78.39 (−362.8, 206) | −10.82 (−45.92, 24.29) |
Carbapenems | 72.39 | −0.081 (−0.510, 0.349) | −50.691 (−56.95,−44.43) | 0.109 (−0.349, 0.569) | −42.68 (−79.66, −5.69) | −66.19 (−87.03, −45.34) |
Third- and fourth-generation cephalosporins | 80.15 | 0.416 (−0.442, 1.274) | 0.347 (−10.94, 11.63) | −0.319 (−1.302, 0.664) | −22.92 (−98.41, 52.56) | −18.95 (−70.16, 32.24) |
β-lactams and β-lactamase inhibitors | 185.5 | −0.342 (−1.635, 0.952) | 21.25 (1.86, 40.64) | 0.746 (−0.634, 2.127) | 75.72 (−35.8, 187.3) | 49.8 (−59.28, 158.8) |
Quinolones | 104.1 | 0.01 (−0.419, 0.442) | 16.74 (10.01, 23.47) | −2.65 (−3.022, −2.288) | −42.86 (−79.92, −5.79) | −40.68 (−61.93, −19.43) |
Aminoglycosides | 21.35 | −0.167 (−0.487, 0.153) | 1.121 (−3.827, 6.069) | 0.155 (−0.179, 0.489) | 12.421 (−15.05, 39.89) | 248.2 (−1645, 2142) |
Outcomes | Regression Intercept | Pre-Intervention Trend | Change in Level a | Change in Trend b | Absolute Effect c | Relative Effect (%) c |
---|---|---|---|---|---|---|
Incidence density | 0.404 | 0.006 (−0.004, 0.015) | −0.284 (−0.434, −0.135) | −0.008 (−0.017, −0.002) | −0.819 (−1.634, −0.003) | −88.14 (−100.4, −75.85) |
14-day crude death rate | 0.097 | 0.001 (−0.003, 0.005) | −0.066 (−0.129, −0.002) | −0.001 (−0.006, 0.003) | −0.164 (−0.515, 0.186) | −85.28 (−115.1, −55.39) |
28-day crude death rate | 0.110 | 0.002 (−0.003, 0.007) | −0.084 (−0.160, −0.007) | −0.003 (−0.008, 0.002) | −0.302 (−0.722, 0.119) | −88.85 (−105.3, −72.36) |
Year | Number of Kp Infections | Number of CR-Kp infections | Resistance Proportion (%) |
---|---|---|---|
2012 * | 140 | 64 | 45.7% |
2013 | 188 | 121 | 64.4% |
2014 | 205 | 118 | 57.6% |
2015 | 138 | 47 | 34.1% |
2016 | 266 | 45 | 16.92% |
2017 | 260 | 32 | 12.30% |
2018 | 259 | 54 | 20.85% |
2019 | 284 | 35 | 12.32% |
2020 ** | 36 | 3 | 8.3% |
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López-Viñau, T.; Muñoz-Rosa, M.; Ruiz-Lara, L.M.; García-Martínez, L.; Machuca, I.; Gracia-Ahufinger, I.; Montero, R.R.; Castón, J.J.; Cano, Á.; Ruiz-Arabi, E.; et al. Long-Term Clinical and Ecological Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem-Resistant Klebsiella pneumoniae Infections in a High-Endemic Hospital. Antibiotics 2024, 13, 792. https://doi.org/10.3390/antibiotics13090792
López-Viñau T, Muñoz-Rosa M, Ruiz-Lara LM, García-Martínez L, Machuca I, Gracia-Ahufinger I, Montero RR, Castón JJ, Cano Á, Ruiz-Arabi E, et al. Long-Term Clinical and Ecological Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem-Resistant Klebsiella pneumoniae Infections in a High-Endemic Hospital. Antibiotics. 2024; 13(9):792. https://doi.org/10.3390/antibiotics13090792
Chicago/Turabian StyleLópez-Viñau, Teresa, Montserrat Muñoz-Rosa, Lidia Mª Ruiz-Lara, Lucrecia García-Martínez, Isabel Machuca, Irene Gracia-Ahufinger, Rafael Ruiz Montero, Juan José Castón, Ángela Cano, Elisa Ruiz-Arabi, and et al. 2024. "Long-Term Clinical and Ecological Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem-Resistant Klebsiella pneumoniae Infections in a High-Endemic Hospital" Antibiotics 13, no. 9: 792. https://doi.org/10.3390/antibiotics13090792