Giuseppe Davide Albano, MD

With concerns growing about antibiotic-resistant bacteria driving up rates of hospital-acquired infections, a team of Italian investigators have found an antimicrobial stewardship program could lead to a number of positive outcomes, including lower mortality and hospital readmissions caused by infections like clostridiodes difficile infections (CDI).

A team, led by Giuseppe Davide Albano, MD, Section of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, implemented an antimicrobial stewardship program and evaluated it for a number of clinical, economic, and microbiological measures.

Growing Concerns Over Infections

“Healthcare-Acquired Infections (HAIs) are serious healthcare complications affecting hospital stay, in-hospital mortality, and costs,” the authors wrote. “Root cause analysis has identified the inappropriate use of antibiotics as the main causative factor in the expansion of multi-drug-resistant organisms (MDRO) in our hospital.”

The overuse of antibiotics may be driving the emergence and spread of antibiotic-resistant bacteria throughout the world.

The investigators implemented an Antimicrobial Stewardship (AMS) program to optimize antibiotic use in a 227 bed hospital in southern Italy, limit the development of resistance, improve therapeutic efficacy and clinical outcomes, while reducing costs.

The Antimicrobial Stewardship Program

The team utilized different stewardship strategies, including antimicrobial oversight on critical antibiotics, developing hospital guidelines on antibiotic selection with the production of a consensus document, and implemented clinical and management control algorithms with visual impact and Business Intelligence methods.

They also used other strategies including training and updating and monitoring of outcome measures and process indicators.

“The aim was to improve the treatment of infections through the rationalization of the use of antibiotics in hospitalized patients at the Giglio Foundation with bacterial infectious diseases,” the authors wrote.

The investigators sought main clinical outcome indicators of overall mortality, mortality and intensive care unit (ICU) admissions caused by infections, length of stay, and hospital readmission.

They also sought microbiological outcome measures of the incidence of C difficile diarrhea. Finally, they sought economic outcomes through antibiotic consumption and cost analysis.

The results after 1 year show the length of hospital stays were reduced by .23 days, while hospital readmission or first month rates were decreased by 19% (P = 0.003).

ICU admissions from medical and surgical wards for infectious complications also were reduced by 28% (n = 60/209 vs. n = 47228; P = 0.04).

For the C difficile analysis, the investigators found a reduction from 16 of 97 positive stool samples in 2020 to 15 of 171 positive stool samples in 2021. The incidence of colitis was reduced by 43.4% year over year.

The overall mortality rate caused by infections was also reduced by 8.8% (P = 0.36), as well as a 9.6% reduction in deaths from infection.

For the economic analysis, the investigators observed a 4.8% reduction in the quantitative consumption of antibiotics, resulting in a 23% reduction in the average cost per discharged patient.

The incidence of C difficile colitis was reduced by 9.1%, while there was an addition reduction in antimicrobial costs by 35% on average fees for discharged patients.

“The systematic application of the AMS program in a small hospital led to multiple improvements in clinical, microbiological, and economic outcome measures,” the authors wrote. “The analysis of the core indicators for our hospital AMS program showed a significant adherence to the model and hospital recommendations.”

The study, “Implementation of A Year-Long Antimicrobial Stewardship Program in A 227-Bed Community Hospital in Southern Italy,” was published online in the International Journal of Environmental Research and Public Health.