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Trends of Adult Antimicrobial Hospital Consumption in Catalonia (Spain) from 2008 to 2018
- Santiago Grau, Sergi Hernández, Ariadna Padullés, Montserrat Gimenez, Lucía Boix-Palop, Susana Melendo, Glòria Oliva, Juan P. Horcajada
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s500-s501
- Print publication:
- October 2020
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Background: Antimicrobial resistance is a disturbing problem in the health system. A relationship between the use of certain antimicrobials and a resistance increase has been proposed. Since this phenomenon is not usually attributed to specific uses of antimicrobials but preferably to its evolution over the years, the analysis of the antimicrobial consumption over time can justify the epidemiological situation of a given region in terms of resistance and possible increases and decreases for specific microorganisms. The objective of this study was to analyze the evolution of the use of antimicrobials in Catalonia during 2008–2018 through the VINCat program (Infection Control and Antimicrobial Stewardship Catalonian Program). Methods: The number of hospitals participating in the VINCat increased from 46 in 2008 to 63 in 2018 (ie, 68.8% and 85.7% of all adult acute-care hospital beds in Catalonia, respectively). Hospitalization days recorded at the participating hospitals increased from 2,991,053 in 2008 to 3,714,938 in 2018. The Anatomical Therapeutic Chemical Classification (ATC) defined daily dose (DDD) index was used for monitoring antimicrobial consumption. Simple linear regressions were performed, the linear relationship was checked by ANOVA tests, and the Pearson correlation (Pc) coefficients were obtained. Values of P ≤ .05 were considered statistically significant. Results: From 2008 to 2018, there was a statistically significant increase of global antibacterial consumption (65.50 vs 71.73 DDD per 100 bed days; P = .001) and antimycotic consumption (3.09 vs 3.45 DDD per 100 bed days, P = .012) due to an increase of consumption in the surgical units. At the same time, there was a decrease in the consumption of antimycotics in the medical units (4.35 vs 3.90 DDD per 100 bed days; P =.029). Cephalosporins and carbapenem consumption increased both globally (10.88 vs 13.86 DDD per 100 bed days; P < .001) and in medical and surgical units (3.26 vs 5.38 DDD per 100 bed days; P < .001). This increase was mainly associated with ceftriaxone (3.45 vs 5.46 DDD per 100 bed days; P < .001) and meropenem (1.12 vs 3.08 DDD per 100 bed days; P < .001). There was a global decrease in the consumption of penicillins (26.10 vs 24.24 DDD per 100 bed days; P = .012) and quinolones (11.63 vs 9.61 DDD per 100 bed days; P = .004). This trend was observed also in ICUs and medical units but not in surgical units, for which only quinolones showed a significant decrease. Decreases in the use of amoxicillin/clavulanate acid (17.80 vs 14.24 DDD per 100 bed days; P < .001) and ciprofloxacin (5.68 vs 4.01 DDD per 100 bed days; P < .001) were observed. Conclusions: The increase in the use of antimicrobials in Catalonia is concerning. This increase is attributable to the use of these drugs in surgical units. Antibiotic stewardship measures should be aimed primarily at these units. The increasing use of carbapenems should be analyzed.
Funding: None
Disclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini as well as speaker honoraria from MSD, Pfizer, and Zambon.
Improvement of Adequacy of Empirical Antimicrobial Therapy in Escherichia coli Bacteremia of Urinary Source in Catalonia (VINCat-PROA)
- Juan P. Horcajada, Sergi Hernández, Ariadna Padullés, Montserrat Gimenez, Boix-Palop Lucía, Ricard Ferrer, Susana Melendo, Josep Maria Badia, Glòria Oliva, Esther Calbo, Santiago Grau
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s483
- Print publication:
- October 2020
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Background: The antibiotic use optimization program (PROA) in Catalonia (Spain) is part of the surveillance program for nosocomial infections in hospitals in Catalonia (VINCat). Despite the existence of guidelines for the treatment of urinary tract infections in hospitals, adherence to them is not guaranteed. Objective: Our objective was to evaluate the adequacy of empirical antimicrobial therapy to local guidelines in bacteremia caused by Escherichia coli of urinary source within the PROA-VINCat program during a 3-year period. The impact of a voluntary survey asking for evaluating local results and implementing correction measures was also analyzed. Methods: Multicentric prospective observational study including all episodes of E. coli bacteremia of urinary source between May 2017 and September 2019, in adult hospitalized patients in 45 Catalan hospitals. Adequacy of the empirical therapy to local guidelines was one of the prospectively recorded items. A survey evaluating local results of 2017–2018 and asking for possible correcting measures was sent to the participating centers at the end of 2018. Percentages of adequacy of empirical antimicrobial therapy in 2017, 2018, and 2019 were compared by means of χ2 test. Results: Overall, 3,804 episodes of bacteremia were recorded: 845 in 2017, 1,861 in 2018 and 1,098 until September 30, 2019. Globally, adequacy of empirical therapy to guidelines increased from 73.7% in 2017 to 78.2% in 2019 (P = .06). Interestingly, in the 24 hospitals that responded to the voluntary survey, the adequacy of empirical therapy increased significantly from 72.9% in 2017 to 79.9% in 2019 (P = .009). In hospitals that did not respond, adequacy remained the same over the years (76.7% in 2017, 75.1% in 2019; P = .90). Correction measures applied were: meeting with the antimicrobial stewardship team to evaluate the results (100%), review of local resistance rates (62%), review of local guidelines (58.3%), improving guidelines dissemination (75%), sessions for improving guidelines adherence (58%), and analysis of adherence to guidelines after education (65%). Conclusions: In the empirical treatment of E. coli bacteremia of urinary source, adequacy to local antimicrobial therapy guidelines improved from 2017 to 2019, but only in hospitals answering a voluntary survey regarding correcting measures for improving adequacy. Adherence to antimicrobial stewardship proposals improves indicators at local and regional level.
Funding: None
Disclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini and speaker honoraria from MSD, Pfizer, and Zambon.
VP84 A Synthetic Index To Assess The Quality Of Care Of Acute Hospitals
- Laura Muñoz Ortiz, Noemi Robles, Josep Davins, Mireia Espallargues, Mercè Mercader, Gloria Oliva
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, p. 188
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INTRODUCTION:
One of the initiatives promoted by the Department of Health of Catalonia to promote the policies of clinical safety and quality of care was the construction of a synthetic indicator to obtain a global ranking that assess the quality of care and recognizes the best acute hospitals in Catalonia.
METHODS:For the selection of dimensions and individual indicators, focus groups with experts, focus groups with patient representatives and a wide consensus process with health professionals were carried out. Weights of dimensions and indicators have been obtained from this consensus with experts. We identified fourty-seven individual indicators grouped into four dimensions, fourty-nine hospitals grouped into five categories were included. Goal programming methodology was used to construct synthetic dimensional indicators and then aggregate to obtain the global ranking based on the global synthetic indicator.
RESULTS:The best situation regarding quality of care of general acute hospitals is achieved in hospitals with better indicators of both the clinical effectiveness and adequacy dimension and patient safety, specifically the synthetic indicator places the hospitals with lowest percentage of patients with postoperative complications or with lowest percentage of infections of organ-space surgical localization in elective colonic or rectal surgery in a better position. Both in the synthetic global indicator and in the synthetic dimensional indicators, position the county hospitals as the best in the ranking, followed by reference hospitals.
CONCLUSIONS:We have presented a new methodology to assess the quality of care of hospitals which offers several advantages over existing ones. It is designed to be practical and to facilitate obtaining synthetic indicators that can be easily interpreted, based on information provided by the reference value corresponding to each indicator and adjusted by the clinical criterion supported by the consensus of more than 300 experts in the field of the evaluation of hospital care quality.