Scholarlink

Background <p>Several countries have established action plans for antibiotic stewardship programs (ASPs), which recognise the clinical and public health issues of antimicrobial resistance. We evaluated the impact of a multimodal ASP, implemented in 2017 to improve urinary source E.coli bacteraemia in a secondary care hospital in Catalonia, Spain.</p> Methods <p>Prospective, post-intervention, epidemiological study in a single hospital in Catalonia. Patients were included if they were aged ≥ 18 years, were admitted to the hospital for any cause between January 1, 2017 and December 31, 2022, and had urinary-source E.coli bacteraemia. The primary endpoint was adherence to antimicrobial treatment guidelines for urinary-source E.coli bacteraemia. Secondary endpoints included, appropriate antimicrobial treatment use based on in vitro sensitivity; the degree of error in appropriate use of empirical antimicrobial treatments by guideline adherence (yes/no); and the percentage of E. coli antibiotic resistance in these patients.</p> Results <p>Of the 297 patients with urinary-source E.coli bacteraemia, the majority were female (57.9%), and the mean (SD) age was 79.0 (16.9) years. Most urinary-source E.coli bacteraemias were community-acquired (<i>n</i> = 194, 65.3%) vs. healthcare system- (<i>n</i> = 78, 26.3%) or hospital- (<i>n</i> = 25, 8.4%) acquired. Adherence rates to antimicrobial treatment guidelines were high across all years (91.4%; range 83.0% to 97.8%), as was the appropriateness of use based on in vitro sensitivity (93.0%; range: 89.4% to 97.8%). The degree of error in appropriate use of empirical antimicrobial treatments was 3.0% (range: 0% to 6.5%) when guidelines were followed and 50.0% (33.3% to 66.7%) when guidelines were not followed. The percentage of urinary-source E.coli bacteraemia which were resistant to treatment with quinolones (44.7% vs. 22.4%; <i>p</i> = 0.014) and ESBLs (21.3% vs. 12.2%; <i>p</i> = 0.058) reduced significantly from 2017 to 2022. No cases of carbapenem resistance occurred.</p> Conclusions <p>This prospective, single centre study reports a high level of appropriate antimicrobial use, based on both guideline recommendations and in vitro sensitivity testing. Our ASP has been applied successfully over 6 years, resulting in improvements in the empirical antimicrobial treatment of urinary-source E.coli bacteraemia, and a reduction in antimicrobial resistance.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Bacteraemia due to E.coli in urinary tract infections in adults: a prospective epidemiological study following implementation of guidelines in a regional hospital

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年11月11日

查看全文
  • David Blancas-Altabella,
  • Antonella F. Simonetti,
  • Cristina Chico,
  • Silvia Serdà,
  • Eulàlia Jou,
  • Esther Moreno-Rubio,
  • Carlos Pérez-López,
  • João Carmezim,
  • Javier García-Pont

摘要

Background

Several countries have established action plans for antibiotic stewardship programs (ASPs), which recognise the clinical and public health issues of antimicrobial resistance. We evaluated the impact of a multimodal ASP, implemented in 2017 to improve urinary source E.coli bacteraemia in a secondary care hospital in Catalonia, Spain.

Methods

Prospective, post-intervention, epidemiological study in a single hospital in Catalonia. Patients were included if they were aged ≥ 18 years, were admitted to the hospital for any cause between January 1, 2017 and December 31, 2022, and had urinary-source E.coli bacteraemia. The primary endpoint was adherence to antimicrobial treatment guidelines for urinary-source E.coli bacteraemia. Secondary endpoints included, appropriate antimicrobial treatment use based on in vitro sensitivity; the degree of error in appropriate use of empirical antimicrobial treatments by guideline adherence (yes/no); and the percentage of E. coli antibiotic resistance in these patients.

Results

Of the 297 patients with urinary-source E.coli bacteraemia, the majority were female (57.9%), and the mean (SD) age was 79.0 (16.9) years. Most urinary-source E.coli bacteraemias were community-acquired (n = 194, 65.3%) vs. healthcare system- (n = 78, 26.3%) or hospital- (n = 25, 8.4%) acquired. Adherence rates to antimicrobial treatment guidelines were high across all years (91.4%; range 83.0% to 97.8%), as was the appropriateness of use based on in vitro sensitivity (93.0%; range: 89.4% to 97.8%). The degree of error in appropriate use of empirical antimicrobial treatments was 3.0% (range: 0% to 6.5%) when guidelines were followed and 50.0% (33.3% to 66.7%) when guidelines were not followed. The percentage of urinary-source E.coli bacteraemia which were resistant to treatment with quinolones (44.7% vs. 22.4%; p = 0.014) and ESBLs (21.3% vs. 12.2%; p = 0.058) reduced significantly from 2017 to 2022. No cases of carbapenem resistance occurred.

Conclusions

This prospective, single centre study reports a high level of appropriate antimicrobial use, based on both guideline recommendations and in vitro sensitivity testing. Our ASP has been applied successfully over 6 years, resulting in improvements in the empirical antimicrobial treatment of urinary-source E.coli bacteraemia, and a reduction in antimicrobial resistance.