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.
Competing Interests: Potential conflicts of interest. J. M. C. has received travel grants and honoraria as a speaker from Novartis, Astellas Pharma, Pfizer, MSD, Janssen Pharmaceuticals, and AstraZeneca outside the submitted work. A. R. V. has received honoraria as a speaker from Pfizer outside the submitted work. J. M. C. reports funding from Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain. J. M. C., G. P., and J. C. C.-R. report grants from the Instituto de Salud Carlos III, Spanish Government, cofinanced by the European Development Regional Fund (A Way to Achieve Europe), and from the Spanish Network for Research in Infectious Diseases during the conduct of the study. A. B. G.-G. reports funding from the Subprograma Río Hortega and Juan Rodés, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spanish Government. L. H.-H. reports funding from the Subprograma Río Hortega. M. E. P.-I. is a researcher funded by the program Nicolás Monardes, Servicio Andaluz de Salud, Junta de Andalucía, Spain. A. R. V. is supported by the Subprograma Juan Rodés, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spain. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
(© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)