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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

2022; Oxford University Press; Volume: 76; Issue: 5 Linguagem: Inglês

10.1093/cid/ciac834

1537-6591

Germán Peñalva, Juan Carlos Crespo‐Rivas, Ana Belén Guisado-Gil, Ángel Rodríguez-Villodres, María Eugenia Pachón-Ibáñez, Bárbara Cachero-Alba, Blas Rivas-Romero, Josefa Gil-Moreno, María Isabel Galvá-Borras, Mercedes García-Moreno, María Dolores Salamanca-Bautista, Manuel Bautista Martínez-Rascón, María Rosa Cantudo-Cuenca, Ruth Concepción Ninahuaman-Poma, María de los Ángeles Enrique-Mirón, Aurora Pérez-Barroso, Inmaculada Marín-Ariza, Miguel González-Florido, María del Rosario Mora-Santiago, S Belda-Rustarazo, José Antonio Expósito-Tirado, Clara Rosso-Fernández, María Victoria Gil-Navarro, José Antonio Lepe, José Miguel Cisneros, Francisco Pérez, Virginia Martínez-Ortega, Begoña Palop-Borrás, Jesús María Fernández-Martín, Francisco Pradas de la Fuente, Pedro Suárez-Uceda, Antonio Andrés Quesada-Sanz, M. López-López, María Teresa Ruiz-Rico, Javier Sánchez, José María Jiménez-Páez, María Rocío Luque-Montilla, Lucrecia García-Martinez, Pilar Egea-Miranda, Francisco José Aguilera, Carmen Amores-Antequera, José Manuel Fernández-Suárez, Virginia Gutiérrez-Rojas, Antonio Francisco Guzmán-González, Raquel Sánchez-Moral, Manuel Cámara-Mestres, María Carmen Domínguez-Jiménez, Dulcenombre María García-Delgado, José Piedrabuena-Molina, María Dolores López-Prieto, V Vazquez-Vela, Juan Bautista Lázaro, María Carmen Cruz-Díaz, R. Robles de Medina, Ana Isabel Aller-García, Ana Sánchez, Julio Cañizares, Laura Lahera, R. Ramos-Moreno, Carmen M. Puche, G. J. Villares, O. Sanchez Hurtado, Fernando Fernández Sánchez, Cristina Sánchez-Martı́nez, Josefa Caballero, María González-López, Manuel Rodríguez-Maresca, Susana Cifuentes-Cabello, Waldo Eugenio Sánchez-Yebra, María Carmen Ruiz-Antón, Mónica Figueroa-Molina, José Bernardo Molina-Cabello, Francisco Ferrer-Amate, Inés Ruiz-Molina, Francisca Vilches, Yolanda Santaella-Guardiola, José Ramón Ávila-Álvarez, Myriam Gallego-Galisteo, Gema Labrador-Herrera, Laura Herrera‐Hidalgo, Silvia Jiménez‐Jorge,

Patient Satisfaction in Healthcare

Abstract 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.