Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design, Setting, and Study Periods
2.2. Sources of Information
2.3. Measurement of Consumption and Microbiological Impact Outcomes
2.4. Evaluation Methods
2.5. Statistical Analysis
3. Results
3.1. Impact on Antibiotic Consumption
3.2. Impact on Antimicrobial Resistance
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Prescribed Antibiotic | DID Pre-Intervention Period | Relative Change First Semester 2017 (95% CI) | Relative Change First Semester 2019 (95% CI) | Relative Change Second Semester 2021 (95% CI) | Absolute Effect Post-Intervention Period | Relative Effect (%) |
---|---|---|---|---|---|---|
Total antibiotics (J01) | 2.496 | 0.892 (0.890 to 0.894) | 0.790 (0.787 to 0.781) | 0.670 (0.668 to 0.672) | −0.688 (−0.691 to −0.685) | 27.57 (27.65 to 27.49) |
Total antibiotics not recommended (ANR) | 1.476 | 0.989 (0.987 to 0.992) | 0.796 (0.793 to 0.797) | 0.581 (0.579 to 0.583) | −0.079 (−0.079 to −0.079) | 37.57 (37.48 to 37.66) |
Co-amoxclav (J01CR02) | 0.704 | 0.940 (0.938 to 0.943) | 0.821 (0.819 to 0.824) | 0.659 (0.657 to 0.662) | −0.250 (−0.251 to −0.249) | 35.59 (35.50 to 35.68) |
Quinolones (J01M) | 0.311 | 0.903 (0.897 to 0.908) | 0.588 (0.584 to 0.593) | 0.328 (0.325 to 0.331) | −0.294 (−0.295 to −0.294) | 94.74 (94.72 to 94.75) |
Ciprofloxacin (J01MA02) | 0.114 | 0.779 (0.770 to 0.788) | 0.556 (0.549 to 0.564) | 0.439 (0.433 to 0.446) | −0.052 (−0.052 to −0.051) | 45.39 (45.07 to 45.70) |
Levofloxacin (J01MA12) | 0.132 | 1.055 (1.046 to 1.065) | 0.730 (0.722 to 0.738) | 0.338 (0.332 to 0.344) | −0.065 (−0.065 to 0.064) | 49.18 (48.93 to 49.44) |
Cephalosporins (J01D) | 0.111 | 1.115 (1.104 to 1.126) | 0.785 (0.776 to 0.794) | 0.807 (0.798 to 0.816) | −0.025 (−0.026 to −0.025) | 22.99 (22.61 to 23.38) |
Cefuroxime (J01DC02) | 0.061 | 0.739 (0.726 to 0.751) | 0.614 (0.603 to 0.625) | 0.433 (0.424 to 0.442) | −0.025 (−0.025 to −0.025) | 40.96 (40.50 to 41.41) |
Third-generation cephalosporins (J01DD) | 0.046 | 1.223 (1.204 to 1.242) | 0.967 (0.971 to 1.004) | 1.275 (1.256 to 1.294) | 0.001 (0.001 to 0.001) | 2.32 (1.57 to 3.07) |
Azithromycin (J01FA10) | 0.152 | 1.204 (1.194 to 1.213) | 1.119 (1.110 to 1.128) | 0.533 (0.527 to 0.539) | −0.042 (−0.043 to −0.041) | 27.67 (27.36 to 27.98) |
Clindamycin (J01FF01) | 0.021 | 0.771 (0.750 to 0.793) | 0.720 (0.699 to 0.741) | 0.846 (0.824 to 0.869) | −0.004 (−0.005 to −0.004) | 21.57 (20.61 to 22.51) |
Total recommended antibiotics (RA) | 0.969 | 1.032 (1.028 to 1.035) | 1.146 (1.143 to 1.150) | 0.748 (0.746 to 0.751) | −0.052 (−0.052 to −0.051) | 21.29 (21.17 to 22.42) |
Amoxicillin (J01CA04) | 0.925 | 1.028 (1.027 to 1.029) | 1.081 (1.081 to 1.082) | 0.711 (0.709 to 0.712) | −0.218 (−0.218 to −0.217) | 23.53 (23.48 to 23.59) |
Cloxacillin (J01CF02) | 0.018 | 1.018 (0.991 to 1.046) | 1.032 (1.005 to 1.060) | 0.722 (0.700 to 0.745) | −0.004 (−0.005 to −0.004) | 25.17 (24.18 to 26.15) |
Cefadroxil (J01DB05) | 0.001 | 1.652 (1.418 to 1.924) | 2.702 (2.380 to 3.066) | 8.835 (8.066 to 9.678) | 0.002 (0.002 to 0.002) | 84.02 (82.80 to 85.14) |
Cotrimoxazole (J01EE01) | 0.027 | 1.158 (1.134 to 1.182) | 1.416 (1.390 to 1.443) | 1.956 (1.924 to 1.988) | 0.014 (0.013 to 0.014) | 33.89 (33.26 to 34.52) |
Antimicrobial Resistance | Comparisons by Semesters (S) | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Second S 2016 vs. Second S 2017 | Second S 2016 vs. Second S 2019 | Second S 2016 vs. First S 2022 | |||||||||||||
% (n/N) Pre-Intervention Resistance | % (n/N) Post-Intervention Resistance | OR CI 95% | p | % (n/N) Pre-Intervention Resistance | % (n/N) Post-Intervention Resistance | OR CI 95% | p | Prevention Rate (%) | % (n/N) Pre-Intervention Resistance | % (n/N) Post-Intervention Resistance | OR CI 95% | p | Prevention Rate (%) | ||
MSSA | Clindamycin | 6.54 (48/734) | 16.08 (23/143) | 2.73 (1.60–4.67) | <0.001 | 6.53 (48/734) | 17.89 (34/190) | 3.11 (1.94–4.99) | <0.001 | NA | 6.53 (48/734) | 19.10 (34/178) | 3.37 (2.09–5.42) | <0.001 | NA |
Levofloxacin | 17.71 (130/734) | 13.22 (19/143) | 0.71 (0.42–1.19) | NS | 17.71 (130/734) | 6.84 (13/190) | 0.34 (0.18–0.61) | <0.001 | 61.4 (33.2–77.6) | 17.71 (130/734) | 10.11 (18/178) | 0.52 (0.30–0.88) | 0.014 | 42.9 (9.10–64.1) | |
Erythromycin | 19.20 (141/734) | 22.07 (33/143) | 1.26 (0.82–1.93) | NS | 19.20 (141/734) | 21.57 (41/190) | 1.15 (0.78–1.71) | NS | NA | 19.20 (141/734) | 22.47 (40/178) | 1.21 (0.81–1.81) | NS | NA | |
MRSA | Clindamycin | 28.30 (75/265) | 38.35 (28/73) | 1.57 (0.91–2.71) | NS | 28.30 (75/265) | 45.31 (29/64) | 2.09 (1.19–3.67) | 0.009 | NA | 28.30 (75/265) | 51.11 (23/45) | 2.64 (1.39–5.03) | 0.002 | NA |
Levofloxacin | 90.94 (241/265) | 93.15 (68/73) | 1.35 (0.49–3.68) | NS | 90.94 (241/265) | 79.63 (50/64) | 0.39 (0.18–0.81) | 0.010 | 12.37 (0.27–23.01) | 90.94 (241/265) | 81.25 (39/45) | 0.43 (0.18–0.99) | 0.044 | 10.6 (−2.83–22.4) | |
Erythromycin | 42.64 (113/265) | 56.62 (47/73) | 1.75 (1.06–2.88) | 0.026 | 42.64 (113/265) | 46.87 (30/64) | 1.18 (0.68–2.05) | NS | NA | 42.64 (113/265) | 51.11 (23/45) | 1.40 (0.74–2.64) | NS | NA |
Antimicrobial Resistance | ID Pre-Intervention Period (95% CI) | Relative Change Second Semester 2017 (95% CI) | Relative Change Second Semester 2019 (95% CI) | Relative Change First Semester 2022 (95% CI) | Absolute Effect Post-Intervention Period | Relative Preventable Effect (%) |
---|---|---|---|---|---|---|
MSSA | ||||||
Clindamycin | 0.024 (0.024 to 0.024) | 2.860 (1.740 to 4.703) | 4.170 (2.687 to 6.471) | 4.071 (2.623 to 6.371) | 0.065 (0.054 to 0.076) | 73.11 (63.67 to 80.10) |
Levofloxacin | 0.065 (0.064 to 0.065) | 0.872 (0.539 to 1.412) | 0.588 (0.332 to 1.041) | 0.795 (0.486 to 1.302) | −0.008 (−0.021 to 0.005) | 12.33 (−8.65 to 29.25) |
Erithromycin | 0.071 (0.070 to 0.071) | 1.397 (0.956 to 2.040) | 1.712 (1.209 to 2.424) | 1.630 (1.147 to 2.316) | 0.041 (0.026 to 0.056) | 39.92 (23.81 to 47.77) |
MRSA | ||||||
Clindamycin | 0.037 (0.037 to 0.038) | 2.229 (1.444 to 3.440) | 2.276 (1.483 to 3.494) | 1.762 (1.104 to 2.812) | 0.040 (0.028 to 0.052) | 51.93 (38.18 to 62.62) |
Levofloxacin | 0.120 (0.119 to 0.120) | 1.684 (1.287 to 2.204) | 1.246 (0.921 to 1.685) | 0.858 (0.604 to 1.218) | 0.022 (0.003 to 0.041) | 15.48 (1.80 to 27.26) |
Erithromycin | 0.056 (0.056 to 0.057) | 2.483 (1.767 to 3.489) | 1.563 (1.045 to 2.337) | 1.169 (0.747 to 1.831) | 0.045 (0.031 to 0.060) | 44.73 (31.96 to 55.10) |
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Jover-Sáenz, A.; Ramírez-Hidalgo, M.; Bellés Bellés, A.; Ribes Murillo, E.; Batlle Bosch, M.; Ribé Miró, A.; Mari López, A.; Cayado Cabanillas, J.; Piqué Palacín, N.; Garrido-Calvo, S.; et al. Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years. Antibiotics 2024, 13, 92. https://doi.org/10.3390/antibiotics13010092
Jover-Sáenz A, Ramírez-Hidalgo M, Bellés Bellés A, Ribes Murillo E, Batlle Bosch M, Ribé Miró A, Mari López A, Cayado Cabanillas J, Piqué Palacín N, Garrido-Calvo S, et al. Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years. Antibiotics. 2024; 13(1):92. https://doi.org/10.3390/antibiotics13010092
Chicago/Turabian StyleJover-Sáenz, Alfredo, María Ramírez-Hidalgo, Alba Bellés Bellés, Esther Ribes Murillo, Meritxell Batlle Bosch, Anna Ribé Miró, Alba Mari López, José Cayado Cabanillas, Neus Piqué Palacín, Sònia Garrido-Calvo, and et al. 2024. "Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-Resistant Staphylococcus aureus Strains across a Region of Catalunya (Spain) over 5 Years" Antibiotics 13, no. 1: 92. https://doi.org/10.3390/antibiotics13010092