Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis.
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Peñalva Germán, Crespo-Rivas Juan Carlos, Guisado-Gil Ana Belén, Rodríguez-Villodres Ángel, Pachón-Ibáñez María Eugenia, Cachero-Alba Bárbara, Rivas-Romero Blas, Gil-Moreno Josefa, Galvá-Borras María Isabel, García-Moreno Mercedes, Salamanca-Bautista María Dolores, Martínez-Rascón Manuel Bautista, Cantudo-Cuenca María Rosa, Ninahuaman-Poma Ruth Concepción, Enrique-Mirón María de Los Ángeles, Pérez-Barroso Aurora, Marín-Ariza Inmaculada, González-Florido Miguel, Mora-Santiago María Del Rosario, Belda-Rustarazo Susana, Expósito-Tirado José Antonio, Rosso-Fernández Clara María, Gil-Navarro María Victoria, Lepe-Jiménez José Antonio, Cisneros José Miguel, PROA-SENIOR Study Group
Аннотация
METHODS: We performed a cluster, randomized, controlled trial and a before-after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD).
RESULTS: The total mean antimicrobial consumption decreased by 31.2% (-16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin-clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (-14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P < .0001).
CONCLUSIONS: This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic. Clinical Trials Registration. NCT03543605.