Resultados de la implementación de un programa piloto de optimización de antimicrobianos (PROA) en Atención Primaria
- N. Alzueta Isturiz
- C. Fontela Bulnes
- A. Echeverría Gorriti
- A. Gil Setas
- P. Aldaz Herce
- J. Garjón Parra
ISSN: 1137-6627
Datum der Publikation: 2020
Ausgabe: 43
Nummer: 3
Seiten: 373-379
Art: Artikel
Andere Publikationen in: Anales del sistema sanitario de Navarra
Zusammenfassung
Background. The aim of this study was to evaluate the implementation of a pilot antimicrobial stewardship program (ASP) in Primary Health Care teams (PHCT) in Navarre (Spain). Material and methods. Non-randomized experimental study performed with data obtained from the electronic pharmacy records. Differences in consumption of antibiotics before (2018) and after (2019) ASP implementation in twelve PHCT were calculated. Another twelve PHCT without ASP were used for comparison. We analysed data on global and beta-lactams, fluoroquinolones, macrolides, cephalosporines and fosfomycin-trometamol, expressed in number of treated patients and DDD (defined daily doses). Results. The number of patients with prescribed antibiotics decreased significantly more in PHCT with ASP (-9.1 vs. -1.7%), particularly with fluoroquinolones (-25 vs. -20.4%), macrolids (-20.4 vs. -8.5%) and amoxicillin-clavulanic (-10.3 vs. -2.5%). Decreased DDD followed the same pattern. Both PHCT groups kept constant the number of patients with prescribed third generation cephalosporins, while those with prescribed first generation cephalosporins and betalactamase-sensible penicilins increased similarly. In PHCT with ASP, increased number of patients with prescribed phosphomycin-trometamol was smaller (4.0 vs. 11.5%) while its consumption expressed in DDDs was reduced while increasing in PHCT without ASP (-1 vs. 10%, p<0.001). Conclusions. PHCT with ASP resulted in a significantly greater decrease in the global use of antimicrobials, fluoroquinolones, macrolides and amoxicillin-clavulanic than PHCT without ASP. These very positive results promoted their extension to the remaining PHCT
Bibliographische Referenzen
- Citas 1. Plan Nacional frente a la Resistencia a los Antibióticos (PRAN) 2019-2021. Agencia Española del Medicamento y Productos Sanitarios (AEMPS) 2019. Consultado el 20 de febrero de 2020. http://www.resistenciaantibioticos.es/es/system/files/field/files/pran_2019-2021_0.pdf?file=1&type=node&id=497&force=0
- RODRÍGUEZ-BAÑO J, PAÑO-PARDO JR, ALVAREZ-ROCHA L, ASENSIO A, CALBO E, CERCENADO E et al. Programas de optimización de uso de antimicrobianos (PROA) en hospitales españoles: documento de consenso GEIH-SEIMC, SEFH y SEMPSPH. Enferm Infecc Microbiol Clin 2012; 30: 22.e1-22.e23. https://doi.org/10.1016/j.eimc.2011.09.018
- CASSINI A, HÖGBERG LD, PLACHOURAS D, QUATTROCCHI A, HOXHA A, SIMONSEN GS et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56-66. https://doi.org/10.1016/S1473-3099(18)30605-4
- PETERSEN I, HAYWARD AC. Antibacterial prescribing in primary care. J Antimicrob Chemother. 2007; 60 (Suppl 1): i43-i47. https://doi.org/10.1093/jac/dkm156
- Programa PIRASOA: Programa integral de prevención, control de las infecciones relacionadas con la asistencia sanitaria y el uso apropiado de los antimicrobianos. 2014. Consultado el 21 de febrero de 2020. http://pirasoa.iavante.es/pluginfile.php/10991/mod_resource/content/1/ProgPIRASOA_vs.12.pdf
- FERNÁNDEZ URRUSUNO R, SERRANO MARTINO C, CORRAL BAENA S. Guía de terapéutica antimicrobiana del Área Aljarafe. 2012. 3ª ed. http://www.sspa.juntadeandalucia.es/servicioandaluzdesalud/guiaterapeuticaaljarafe/guiaTerapeuticaAljarafe/guia/guia.asp
- Plan Nacional frente a la Resistencia a los Antibióticos (PRAN). Programa de optimización de uso de antibióticos (PROA). Agencia Española del Medicamento y Productos Sanitarios (AEMPS) 2017. Consultado el 20 de febrero de 2020. http://www.resistenciaantibioticos.es/es/system/files/field/files/prorgramas_de_optimizacion_de_uso_de_antibioticos_proa.pdf?file=1&type=node&id=363&force=0
- FERNÁNDEZ URRUSUNO R, MESEGUER BARROS CM, BENAVENTE CANTALEJO RS, HEVIA E, SERRANO MARTINO C, IRASTORZA ALDASORO A et al. Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis. PLoS One 2020; 15: e0233062. https://doi.org/10.1371/journal.pone.0233062
- PEÑALVA G, FERNÁNDEZ-URRUSUNO R, TURMO JM, HERNÁNDEZ-SOTO R, PAJARES I, CARRIÓN L et al. Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum β-lactamase-producing Escherichia coli in the community: an interrupted time-series analysis. Lancet Infect Dis 2020; 20: 199-207. https://doi.org/10.1016/S1473-3099(19)30573-0
- LLOR C, MORAGAS A, CORDOBA G. Veinticinco mitos en enfermedades infecciosas en atención primaria que se asocian con un sobrediagnóstico y sobretratamiento. Aten Primaria 2018; 50: 57-64. https://doi.org/10.1016/j.aprim.2018.09.005