106-603 / Institutional Program for the Optimization of Antimicrobial Treatment (PRIOAM)

1st year end-points: Improvement of antimicrobial prescription and reduction in antibiotic consumption.
It was considered to be achieved, if a significant increase in CI marks was recorded by the 4th trimester after the implementation of the ASP. Evaluations were performed not only for overall CI, but also specifically in each clinical department. The trend in overall and specific antimicrobial consumption, measured as number of DDD/1000 occupied bed-days, werealso assessed during the same period.

2nd year end-points: clinical and ecological impact of the program.
Data on antibiotic resistance, as well as morbidity and mortality related to severe infections will be prospectively recorded. By the end of the second year, the sample size and the time elapsed is expected to be appropriate to make such comparison. The aforementioned end-points include influence on mortality-morbidity related to severe infections and bacterial resistance, as well as its impact on economic costs.

These data have proven that an educational program with an institutional basis can be as effective as direct-control interventions. The rate of appropriate treatments by the end of the first year was superior to 75%, results that are similar to those published for other audit-based programs.

Our program also achieved an important decrease in all-class antimicrobial consumption by 26%. At the end of 2011, this consumption was recorded to be 874.2 DDD/1000 bed-days. This rate of consumption places our hospital near the average of other tertiary Spanish hospitals in 2009, reported to be 864 DDD. This result is in favour of our center, considering our noticeably higher number of ICU beds (90 beds vs. a mean of 28 ICU beds in other centers) and the especially active transplantation program.

This reduction has not been achieved through restrictive measures targeted towards specific antibiotics, but through the training of clinicians in the sensitive use of antimicrobials. Its pedagogic approach has been the key to the program’s success and its excellent level of acceptance among interviewed clinicians.

Finally, there are novel elements incorporated by this program ensuring its sustainability, e.g. its transversal design, the involvementof clinicians from all departments, the low extra-burden of work required to implicate the proposed pedagogic methodology in daily clinical practice, and the strong institutional support, which has linked the program consecution to economic incentives.