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.
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 t...
| Publicado en: | Clinical Infectious Diseases Vol. 76; no. 5; pp. 824 - 833 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Oxford University Press / USA
Mar2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=162294512&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 162294512 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10584838 46X jtl: Clinical Infectious Diseases issn: 10584838 maglogo: N pubinfo: dt: Mar2023 vid: 76 iid: 5 pid: 622 pub: Oxford University Press / USA artinfo: ui: 162294512 162294512 162294512 10.1093/cid/ciac834 162294512 ppf: 824 ppct: 9 formats: tig: atl: 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. aug: au: Peñalva, Germán Crespo-Rivas, Juan Carlos Guisado-Gil, Ana Belén Rodríguez-Villodres, Ángel Pachón-Ibáñez, María Eugenia Cachero-Alba, Bárbara Rivas-Romero, Blas Gil-Moreno, Josefa Galvá-Borras, María Isabel García-Moreno, Mercedes Salamanca-Bautista, María Dolores Martínez-Rascón, Manuel Bautista Cantudo-Cuenca, María Rosa Ninahuaman-Poma, Ruth Concepción Enrique-Mirón, María de los Ángeles Pérez-Barroso, Aurora Marín-Ariza, Inmaculada González-Florido, Miguel Mora-Santiago, María del Rosario Belda-Rustarazo, Susana affil: 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 sug: subj: Nursing Homes Antibiotics Therapeutic Use Antimicrobial Stewardship Education Outcomes of Education Evaluation Human Spain Randomized Controlled Trials Interrupted Time Series Analysis Interviews Descriptive Statistics Antibiotics Administration and Dosage Inappropriate Prescribing Prevention and Control Drug Resistance, Microbial Prescribing Patterns Funding Source ab: 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. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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