Impact of an antimicrobial stewardship program indicator on the appropriateness of the empiric antibiotic treatment of urinary source Escherichia coli bacteraemia

•An ASP indicator improved treatment of urinary source E. coli bacteriemia.•Surveillance increased guideline adherence to local guidelines from 73.8% to 81%.•88.1% of empirical treatments were appropriate to in vitro activity.•Despite ESBL E. coli increased, guidelines degree of error did not rise s...

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Published in:	International journal of antimicrobial agents Vol. 64; no. 2; p. 107202
Main Authors:	Giménez-Pérez, Montserrat, Hernández, Sergi, Padullés, Ariadna, Boix-Palop, Lucía, Grau, Santiago, Badia, Josep M., Ferrer, Ricard, Calbo, Esther, Limón, Enric, Pujol, Miquel, Horcajada, Juan P., Blanco, Naiara Villalba, Vidal, Rafel Pérez, Fernández, Francisco José Vargas-Machuca, de Gracia García Ramírez, Mª, Castro, Ivan Javier, Serra, Natàlia Juan, Satorra, Rosa Maria Morera, Martorell, Sara Oduber, Huerta, Eduardo Sáez, Carrascosa, Montserrat, Soriano, Ludivina Ibañez, Smithson, Alex, Miserachs, Nuria, Alonso-Tarrés, Carles, Ayuso, Elisabet Farré, González, Maria Priegue, de Ciriza Villacampa, Carmen Pérez, Fernández, María Dolores García, Martins, Marlene Àlvarez, del Río Pérez, Oscar, Riera, Ester Sanfeliu, Bertomeu, Manel Panisello, Flores, Angels García, González, Laura Linares, Pujol, Ester Comellas i, Matias, Guillem Vila, Adell, Claudia Miralles, Marcual, Jaume Llaberia, Sibat, Anna Martinez, Flotats, Elisenda, Roldan, Francina Riu, Martinez, Lorena Gaviria, de Gamarra Martínez, Edurne Fernández, Solchaga, Virginia Pomar, Luque, M. Fernanda Solano, Barque, M. Pilar Barrufet, Nicolas, Elisabeth Mauri, Fidalgo, Arantzazu Mera, Bertran, Nuria Torrellas, Gomila-Grange, Aina, Blasi, Oriol Gasch, Badia, Ester Dorca, Santamaria, Marta Andrés, Pérez-Moreno, Mar Olga, González, Lidia Martín, Fernández, Magda Muelas, Padilla, Eduardo, Zorrilla, Silvia Gomez, Enguidanos, Maria Rosa Laplace, Jofre, Clara Sala, Arango, Mauricio Valencia, Pascua, Pilar Marcos, Chippiraz, Elisabet Lerma, Sureda, Teresa Falgueras, González, Melisa Barrantes, Saballs, Mireia, Taha, Mohamed Sufian Al-dirra, Guitart, Silvia Sancliment, Larrainzar-Coghen, Thais, Toboso, Sebastián Hernández, Rodriguez, Irene Sánchez, Fraile, Maria José, Torras, Sara Garcia, Guitard-Quer, Alba, Castellana-Perelló, Dolors, Sáenz, Alfredo Jover, Ramírez-Hidalgo, María, Pardo, Graciano García, Garriga, Imma Grau, Palau, Damaris Berbel, Moral, Alícia, Vilamala, Anna, Montal, Camil·la Valls, Navarro, Maria, Valls, Mariona Xercavins, Anaya, Gisela Cuadrado, Ochoa, Ivett Suárez, Matellanes, Julen Montoya, Trevisanello, Lucia, Prieto, Natacha Recio, Azcona, Ana Felisa Lopez, Iftimie, Simona Mihaella, Jaime, Laura Cabrera, Margall, Nuri Quer, Laporte, Júlia, Sanmartí, Montserrat, Diaz-Brito, Vicens, Belda, Alejandro Sanjuan, Sanz, Marta Milián
Format:	Journal Article
Language:	English
Published:	Elsevier Ltd 01-08-2024
Subjects:	Antimicrobial stewardship indicator Empiric antibiotic treatment Escherichia coli bacteriemia Escherichia coli sensibility VINCat HCAI RDT Empiric antibiotic treatment Escherichia coli sensibility Antimicrobial stewardship indicator EARS-Net Escherichia coli bacteriemia ESBL ICU ASPs UTI
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Summary:	•An ASP indicator improved treatment of urinary source E. coli bacteriemia.•Surveillance increased guideline adherence to local guidelines from 73.8% to 81%.•88.1% of empirical treatments were appropriate to in vitro activity.•Despite ESBL E. coli increased, guidelines degree of error did not rise significantly.•Guidelines need to be constantly updated with epidemiological and patient data. A prospective multicentre study was carried out between 2017 and 2021 to assess (1) the appropriateness of the empirical treatment to the local guidelines of urinary source Escherichia coli bacteraemia, (2) the appropriateness of empirical treatment to antibiotic sensitivity results and (3) the degree of error in the local guidelines regarding the antibiotic sensitivity reported in acute care hospitals enrolled in the vigilància de les infeccions relacionades amb l'atenció sanitària de Catalunya program. During the study period, 79.0% of the empirical treatments analysed complied with the guidelines and 88.1% were appropriate in view of the in vitro activity of the isolated strain. The rate of appropriateness rose from 73.8% in 2017 to 81.0% in 2021 (P < 0.001). The degree of error in the recommendations regarding the in vitro activity of the isolated strains was 5.9% and remained stable during the study period. Antibiotic families correctly prescribed according to the guidelines were third-generation cephalosporins (54.9%), carbapenems (16.8%) and combinations of penicillins and beta-lactamase inhibitors (16.4%). Of the 8009 E. coli strains, 19.0% were extended-spectrum beta-lactamases producers, 36.8% were resistant to quinolones and 0.5% were resistant to carbapenems. The broad implementation of an antimicrobial stewardship program with quality indicators of antibiotic use improved compliance to local guidelines in the empiric treatment of urinary tract E. coli bacteraemia. The degree of error in local guidelines was low but higher in more complex hospitals and in healthcare-associated infections. Guidelines need to be constantly updated with the use of epidemiological data, rapid diagnostic tests and the analysis of patient risk factors specific to each geographical area. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0924-8579 1872-7913 1872-7913
DOI:	10.1016/j.ijantimicag.2024.107202