Impact of an Antimicrobial Stewardship Program on Resistance to Fluoroquinolones of Urinary Enterobacteriaceae Isolated From Nursing Home Residents: A Retrospective Cohort Study |
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| Institution: | 1. Infectious Diseases Unit, Groupe Hospitalier Sud Ile de France, Melun, France;2. Internal Medicine Unit, Groupe Hospitalier Sud Ile de France, Melun, France;3. Antibiotic Mobile Team, Hospital of Provins, France;4. Observatoire du Médicament des Dispositifs Médicaux et de l''Innovation Thérapeutique, Paris, France;5. Antibiotic Mobile Team, Cochin University Hospital, Paris, France;1. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China;2. Medical Informatics Center, Peking University, Beijing, China;3. Department of Medicine, Yale School of Medicine, New Haven, CT;1. Department of Emergency Medicine, Changi General Hospital, Singapore;2. Department of Geriatric Medicine, Changi General Hospital, Singapore;3. Advanced Diploma Nursing (Emergency Medicine), Nanyang Polytechnic, Singapore;4. Clinical Services, Changi General Hospital, Singapore;5. Health Services Research, Changi General Hospital, Singapore;6. Saint Andrew''s Community Hospital, Singapore;1. Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Lausanne, Switzerland;2. Specialization School in Geriatrics, University of Milan, Milan, Italy;3. Health Services Unit, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland;1. Department of Medicine and Geriatrics, Careggi Hospital and University of Florence, Florence, Italy;2. Centro di Valutazione e Ricerca Gerontologica, Chair of Geriatrics, University of Modena and Reggio Emilia, Modena, Italy;3. SCDU Geriatria e Malattie Metaboliche dell''Osso, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy;4. Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy;5. Department of Health Sciences, University of Milano Bicocca and Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy;6. Medicine and Geriatric Unit, Spedali Civili of Brescia, Brescia, Italy;7. Geriatric Department, SS. Trinità Hospital, Cagliari, Italy;8. S. Maria di Ca'' Foncello Hospital, Treviso, Italy;9. Geriatric Unit, Santa Chiara Hospital, Trento, Italy;10. Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy;11. S. Jacopo Hospital, Azienda USL 3, Pistoia, Italy;12. Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy |
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| Abstract: | ObjectivesThis study investigated the impact of an antimicrobial stewardship program on fluoroquinolone (FLQ) resistance in urinary Enterobacteriaceae isolated from residents of 3 French nursing homes.DesignA multicentric retrospective before-and-after study was conducted.Setting and ParticipantsAll the first urinary Enterobacteriaceae isolates obtained from nursing home residents were included. Two time frames were analyzed: 2013-2015 and 2016-2017.MethodsThe antimicrobial stewardship program started in 2015 and was based on (1) 1-day training for use of an “antimicrobial stewardship kit for nursing homes;” and (2) daily support and training of the coordinating physician by an antibiotic mobile team (AMT) in 2 of 3 nursing homes.ResultsOverall, 338 urinary isolates were analyzed. Escherichia coli was the most frequent species (212/338, 63%). A significant reduction of resistance to ofloxacin was observed between 2013-2015 and 2016-2017 in general (Δ = ?16%, P = .004) and among isolates obtained from patients hospitalized in the county nursing home with AMT support (Δ = ?28%, P < .01). A nonstatistically significant reduction in ofloxacin resistance was also observed in the hospital nursing home with AMT support (Δ = ?18%, P = .06).Conclusions and ImplicationsOur antimicrobial stewardship program resulted in a decrease in resistance to FLQ among urinary Enterobacteriaceae isolated from nursing home residents. The support of an AMT along with continuous training of the coordinating physician seems to be an important component to ensure efficacy of the intervention. |
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| Keywords: | Antimicrobial stewardship fluoroquinolones nursing home urine |
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