Antimicrobial Stewardship: efective implementation for improved clinical outcomes José Miguel Cisneros Herreros Infectious Diseases Department University Hospital Virgen del Rocío, Sevilla, Spain The Challenge of MDR and XDR infections; Barcelona September 2018
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Antimicrobial Stewardship: efective implementation for
improved clinical outcomes
José Miguel Cisneros Herreros
Infectious Diseases Department
University Hospital Virgen del Rocío, Sevilla, Spain
The Challenge of MDR and XDR infections; Barcelona September 2018
Competing interests
• Andalusian Health Service
• Ministry of Health (ISCIII), European Commission
• Novartis, Astellas, Pfizer, MSD, Janssen y Astra-Zeneca
2
Laxaminarayan R et al. Science 2016
Antimicrobial use
1
3
4
2015
https://ecdc.europa.eu/en/antimicrobial-resistance (access 2 July 2017)
Antibiotic use in primare care, Andalucia: Estimated prediction
36
37
11
8,7
7,9
9,1
10,5
7,4 6,7
7,5 8,2
6,4
5,6 6,3
7
5,5 5
5,6
0
2
4
6
8
10
12
DD
D/1
00
0 h
ab. d
ía
Amoxicillin/clavulanic use in primary care
- 49% P <0,05
+2,9% (p<0,01
- 10,5% p<0,05)
Ecological impact in primary care: E. coli BLEE
38 Peñalva G et al. ECCMID 2017
Conclusions:
1. It is possible to implement and maintain an ASP in an entire health system.
2. This program is able to optimize the use of antimicrobials agents, reducing total consumption and improving the prescription profile, and probably contributing to reduce the incidence of MDR pathogens, without increasing the crude death rate associated with bloodstream infections.
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40
Clinical Infectious Diseases® 2017;65:1992–9
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Antimicrobial use
- 217 DDD/1000 OBDs
-19,9%
Clinical Infectious Diseases® 2017;65:1992–9
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Incidence of nosocomial bloodstream infections by MDR bacteria and candidemia
Clinical Infectious Diseases® 2017;65:1992–9
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Incidence of nosocomial bloodstream infections by no-MDR bacteria and candidemia
Clinical Infectious Diseases® 2017;65:1992–9
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Mortality of nosocomial bloodstream infections by MDR bacteria and candidemia
Clinical Infectious Diseases® 2017;65:1992–9
Conclusions:
• The results of this study show that the decrease and better use of antibiotics achieved by our ASP had a sustained ecological and clinical impact, reducing the incidence and mortality rate of hospital-acquired candidemia and MDR BSIs
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Acknowledgments
Andalusian Government Health Counselor
Secretary of Public Health
Managing Director of the Andalusian Health Service
General Director of Health Care
Support Services of the Andalusian Health Service
Strategic Direction of IT
IAVANTE
Canal SUR television
Local teams:
• 638 professionals
Thousands of professionals of the Andalusian Public Healthcare System who have participated