Alba-Fernández, J. (Jorge)

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    Impact of the acceptance of the recommendations made by a meropenem stewardship program in a university hospital: A pilot study
    (MDPI AG, 2022) Blanco, A. (Andrés); Alba-Fernández, J. (Jorge); Aldaz, A. (Azucena); Leiva, J. (José); Pozo, J.L. (José Luis) del; Fernández-Alonso, M. (Miriam); Aquerreta, I. (Irene); Yuste, J.R. (José Ramón)
    Antimicrobial stewardship programs (ASP) promote appropriate antimicrobial use. We present a 4-year retrospective study that evaluated the clinical impact of the acceptance of the recommendations made by a meropenem-focused ASP. A total of 318 meropenem audits were performed. The ASP team (comprising infectious disease physicians, pharmacists and microbiologists) considered meropenem use in 96 audits (30.2%) to be inappropriate. The reasons to consider these uses inappropriate were the possibility of de-escalating to a narrower-spectrum antibiotic, in 66 (68.7%) audits, and unnecessary meropenem use, in 30 (31.3%) audits. The ASP team recommended de-escalation in 66 audits (68.7%) and discontinuation of meropenem in 30 audits (31.3%). ASP interventions were stratified according to whether or not recommendations were followed. The group in which recommendations were accepted and followed (i.e., accepted audit, AA) included 66 audits (68.7%) and the group in which recommendations were not followed (i.e., rejected audit, RA) included 30 (31.3%) audits. The comorbidity of the AA group (Charlson score) was higher than in the RA group (7.0 (5.0–9.0) vs. 6.0 (4.0–7.0), p = 0.02). Discontinuation of meropenem was recommended in 83.3% of audits in the AA group vs. 62.2% in the RA group (OR 3.05 (1.03–8.99), p = 0.04). Ertapenem de-escalation resulted in a 100% greater rate of follow-up compared with the non-carbapenem option (100% vs. 51.9%, OR 1.50 (1.21–1.860), p = 0.001). Significant differences were observed in the AA group when cultures were taken before antibiotic prescription—98.5% vs. 83.3% (p = 0.01, OR 13.0 (1.45–116.86))—or when screening cultures were taken—45.5% vs. 19.2% (p = 0.03, OR 3.5 (1.06–11.52)). There were no differences between the groups in terms of overall mortality and 30-day mortality, length of stay, Clostridiodes difficile infection, 30-day readmission or hospitalization costs. In conclusion, meropenem ASP recommendations contributed to a decrease in meropenem prescription without worsening clinical and economic outcomes.
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    Impacto del seguimiento de la recomendación de un programa de optimización de antiinfecciosos (PROA) sobre la prescripción de meropenem en la Clínica Universidad de Navarra.
    (Universidad de Navarra, 2023-10-05) Alba-Fernández, J. (Jorge); Pozo, J.L. (José Luis) del; Yuste, J.R. (José Ramón)
    A principios del siglo XX las enfermedades infecciosas eran la principal causa de muerte en el mundo (1). Este paradigma cambió con el descubrimiento de la penicilina por Fleming en 1928 (2). A raíz de su utilización en la década de los cuarenta (junto con las vacunas, la higiene hospitalaria y la cloración del agua), la mortalidad por las enfermedades infecciosas disminuyó drásticamente, aumentando la esperanza de vida a 74 años en varones y 80 en mujeres en la década del 2000 (3). Los β-lactámicos representan la familia de antibióticos más utilizados en la actualidad, tanto a nivel comunitario como nosocomial y representan alrededor del 65% de las prescripciones de antibióticos inyectables en Estados Unidos (4). En 2017, La tasa media de consumo comunitario de antibióticos en España fue de 25 DHD (dosis diarias definidas por 1000 habitantes y día), superando significativamente la media europea de 21,8 DHD, y siendo mucho más alta que las tasas de consumo en países del Norte de Europa como Alemania (13,7 DHD), Suecia (11,6 DHD) y Holanda (10,1 DHD) (5).