International Journal of Clinical Pharmacy

, Volume 39, Issue 5, pp 1061–1069 | Cite as

Evaluation of effects of an operational multidisciplinary team on antibiotic use in the medium to long term at a French university hospital

  • Béatrice Demoré
  • Pauline Humbert
  • Emmanuelle Boschetti
  • Sibylle Bevilacqua
  • Isabelle Clerc-Urmès
  • Thierry May
  • Céline Pulcini
  • Nathalie Thilly
Research Article

Abstract

Background Antibiotic-resistant bacteria are a major public health problem throughout the world. In 2006, in accordance with the national guidelines for antibiotic use, the CHRU of Nancy created an operational multidisciplinary antibiotic team at one of its sites. In 2011, a cluster-controlled trial showed that the operational multidisciplinary antibiotic team (the intervention) had a favourable short-term effect on antibiotic use and costs. Objective Our objective was to determine whether these effects continued over the medium to long term (that is, 2–7 years after creation of the operational multidisciplinary antibiotic team, 2009–2014). Setting The 1800-bed University Hospital of Nancy (France). Method The effect in the medium to long term is measured according to the same criteria and assessed by the same methods as the first study. A cluster controlled trial was performed on the period 2009–2014. The intervention group comprised 11 medical and surgical wards in settings where the operational multidisciplinary antibiotic team was implemented and the control group comprised 6 wards without this operational team. Main outcome measure Consumption of antibiotics overall and by therapeutic class (in defined daily doses per 1000 patient-days) and costs savings (in €). Results The reduction in antibiotic use and costs continued, but at a lower rate than in the short term (11% between 2009 and 2014 compared with 33% between 2007 and 2009) at the site of the intervention. The principal decreases concerned fluoroquinolones and glycopeptides. At the site without an operational multidisciplinary antibiotic team (the control group), total antibiotic use remained stable. Between 2009 and 2014, costs fell 10.5% in the intervention group and 5.7% in the control group. Conclusion This study shows that it is possible to maintain the effectiveness over time of such an intervention and demonstrates its role in defining a hospital’s antibiotic policy.

Keywords

Antibiotics Antimicrobial stewardship intervention Consumption DDD France Intervention Multidisciplinary team 

Notes

Acknowledgements

We are grateful to Jo Ann Cahn for the translation and editing of the English version of this document.

Funding

This work was supported by University Hospitals of Nancy (Language translation and editing fees).

Conflicts of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    World Health Organisation. Antimicrobial resistance: global report on surveillance. 2014. http://www.who.int/drugresistance/documents/surveillancereport.
  2. 2.
    Institut de veille sanitaire (InVS) et Agence nationale de sécurité du médicament et des produits de santé (ANSM). Consommation d’antibiotiques et résistance aux antibiotiques en France: nécessité d’une mobilisation déterminée et durable. Bilan des données de surveillance, 18 novembre 2014. Saint-Maurice: Institut de veille sanitaire. 2014. http://www.invs.sante.fr.
  3. 3.
    European Centre for Disease Prevention and Control (ECDC). Surveillance of antimicrobial consumption in Europe. Data 2012. Report October 2014. http://ecdc.europa.eu/en/publications/Publications/antimicrobial-consumption-europe-esac-net-2012.pdf.
  4. 4.
    Borg MA, Zarb P, Ferech M, Goossens H, ARMed Project Group. Antibiotic consumption in southern and eastern Mediterranean hospitals: results from the ARMed project. J Antimicrob Chemother. 2008;62(4):830–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Alfandari S, Robert J, Péan Y, Rabaud C, Bedos JP, Varon E, et al. Antibiotic use and good practice in 314 French hospitals: the 2010 SPA2 prevalence study. Med Mal Infect. 2015;45(11–12):475–80.CrossRefPubMedGoogle Scholar
  6. 6.
    Bevilacqua S, Demoré B, Boschetti E, Doco-Lecompte T, May I, May T, et al. 15 years of antibiotic stewardship policy in the Nancy Teaching Hospital. Med Mal Infect. 2011;41(10):532–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Bevilacqua S, Demoré B, Erpelding ML, Boschetti E, May T, May I, et al. Effects of an operational multidisciplinary team on hospital antibiotic use and cost in France: a cluster controlled trial. Int J Clin Pharm. 2011;33(3):521–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Mach R, Vlcek J, Prusova M, Batka P, Rysavy V, Kubena A. Impact of a multidisciplinary approach on antibiotic consumption, cost and microbial resistance in a Czech hospital. Pharm World Sci. 2007;29(5):565–72.CrossRefPubMedGoogle Scholar
  9. 9.
    Uçkay I, Vernaz-Hegi N, Harbarth S, Stern R, Legout L, Vauthey L, et al. Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit. J Infect. 2009;58(3):205–12.CrossRefPubMedGoogle Scholar
  10. 10.
    Smith T, Philmon CL, Johnson GD, Ward WS, Rivers LL, Williamson SA, et al. Antimicrobial stewardship in a community hospital: attacking the more difficult problems. Hosp Pharm. 2014;49(9):839–46.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hagert B, Williams C, Wiesner C, Rohrich M, Lo T, Newman W, et al. Implementation and outcome assessment of an inpatient antimicrobial stewardship program. Hosp Pharm. 2012;47(12):939–45.CrossRefGoogle Scholar
  12. 12.
    14e Conférence de Consensus organisée par la Société de Pathologie Infectieuse de Langue française (SPILF). Comment améliorer la qualité de l’antibiothérapie dans les établissements de soins? Med Mal Infect. 2001;32:320–8.Google Scholar
  13. 13.
    Magedanz L, Silliprandi EM, dos Santos RP. Impact of the pharmacist on a multidisciplinary team in an antimicrobial stewardship program: a quasi-experimental study. Int J Clin Pharm. 2012;34(2):290–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003;9:699–706.CrossRefGoogle Scholar
  15. 15.
    Mondain V, Lieutier F, Dumas S, Gaudart A, Fosse T, Roger PM, et al. An antibiotic stewardship program in a French teaching hospital. Med Mal Infect. 2013;43(1):17–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Fukuda T, Watanabe H, Ido S, Shiragami M. Contribution of antimicrobial stewardship programs to reduction of antimicrobial therapy costs in community hospital with 429 Beds–before-after comparative two-year trial in Japan. J Pharm Policy Pract. 2014;7(1):10.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Michaels K, Mahdavi M, Krug A, Kuper K. Implementation of an antimicrobial stewardship program in a community hospital: results of a three years analysis. Hosp Pharm. 2012;47(8):608–16.CrossRefGoogle Scholar
  18. 18.
    Gendrin V, Letranchant L, Henard S, Frentiu E, Demoré B, Burty C, et al. Impact of corrective measures on fluoroquinolones prescriptions for urinary tract infections during a 2-round relevance study. Presse Med. 2012;41(1):10–4.CrossRefGoogle Scholar
  19. 19.
    Charbonneau P, Parienti JJ, Thibon P, Ramakers M, Daubin C, du Cheyron D, et al. Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: a quasi-experimental study. Clin Infect Dis. 2006;42:778–84.CrossRefPubMedGoogle Scholar
  20. 20.
    Pulcini C, Mondain V, Lieutier F, Mousnier A, Roger PM, Dellamonica P. Fluoroquinolone prescriptions in a teaching hospital: a prospective audit. Scand J Infect Dis. 2007;39(11–12):1013–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Willemsen I, Cooper B, van Buitenen C, Winters M, Andriesse G, Kluytmans J. Improving quinolone use in hospitals by using a bundle of interventions in an interrupted time series analysis. Antimicrob Agents Chemother. 2010;54:3763–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Galas M, Dunoyer G, Olive C, Théodose R, Legris-Allusson V, Coyo C et al. Mise en place d’un contrôle des prescriptions de carbapénèmes : expérience d’une équipe pluridisciplinaire au CHU de Fort-de-France, Martinique. BEH 2012;42–43:491–3.Google Scholar
  23. 23.
    Bogan C, Marchaim D. The role of antimicrobial stewardship in curbing carbapenem resistance. Future Microbiol. 2013;8:979–91.CrossRefPubMedGoogle Scholar
  24. 24.
    Scheetz MH, Bolon MK, Postelnick M, Noskin GA, Lee TA. Cost-effectiveness analysis of an antimicrobial stewardship team on bloodstream infectious: a probabilistic analysis. J Antimicrob Chemother. 2009;63(4):816–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Chahwakilian P, Huttner B, Schlemmer B, Harbarth S. Impact of the French campaign to reduce inappropriate ambulatory antibiotic use on the prescription and consultation rates for respiratory tract infections. J Antimicrob Chemother. 2011;66(12):2872–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Calloway S, Akilo HA, Bierman K. Impact of a clinical decision support system on pharmacy clinical interventions, documentation efforts, and costs. Hosp Pharm. 2013;48(9):744–52.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Buyle FM, Wallaert M, Beck N, Boelens J, Callens S, Claeys G, et al. Implementation of a multidisciplinary infectious diseases team in a tertiary hospital within an Antimicrobial Stewardship Program. Acta Clin Belg. 2014;69(5):320–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Blix HS, Viktil KK, Moger TA, Reikvam A. Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams. Pharm World Sci. 2006;28(3):152–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Dashti-Khavidaki S, Khalili H, Hamishekar H, Shahverdi S. Clinical pharmacy services in an Iranian teaching hospital: a descriptive study. Pharm World Sci. 2009;31(6):696–700.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Pharmacy, Brabois Hospital, University Hospital of NancyVandoeuvre-lès-NancyFrance
  2. 2.Faculté de PharmacieUMR 7565, SRSMC, CNRS – Lorraine UniversityNancy CedexFrance
  3. 3.Infectious Diseases DepartmentBrabois Hospital, University Hospital of NancyVandoeuvre-lès-NancyFrance
  4. 4.Unité ESPRI-BIOBASE, Plateforme d’Aide à la Recherche CliniqueBrabois Hospital, University Hospital of NancyVandoeuvre-lès-NancyFrance
  5. 5.Host-Environment Relation, EA 4369Lorraine UniversityNancyFrance
  6. 6.Plateforme d’Aide à la Recherche CliniqueBrabois Hospital, University Hospital of NancyVandoeuvre-lès-NancyFrance
  7. 7.EA 4360 ApemacLorraine UniversityNancyFrance

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