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

• Published in: Clinical infectious diseases 2023-03, Vol.76 (5), p.824-832
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents - therapeutic use; COVID-19; Humans; Nursing Homes
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciac834

Abstract Background Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs. 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. Antimicrobial stewardship educational programs can improve antibiotic prescribing patterns and reduce total use of antimicrobials and prevalence of multidrug-resistant organisms in nursing homes without deleterious effects on clinical outcomes, even under unfavorable circumstances such as the coronavirus disease 2019 pandemic.