OBJECTIVES Inappropriate antimicrobial use favours the spread of resistance, and multidrug-resistant microorganisms (MDR) are currently of major concern. Antimicrobial stewardship programmes (ASPs) are essential for improving antibiotic use in hospitals. However, their impact on entire healthcare systems has not been thoroughly assessed. Our objective was to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. METHODS We designed an ecologic time-series study from 1 January 2014 to 31 December 2017. Quarterly, data on indicators were collected prospectively, and feedback reports were provided. PIRASOA is an ongoing clinically based quality-improvement programme whose key intervention is the educational interview, regular peer-to-peer interventions between advisors and prescribers to reinforce the appropriate use of antibiotics. Seventy-two indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses per 1000 occupied bed-days), incidence density of MDR per 1000 occupied bed-days and crude mortality rate associated with bloodstream infections. We used Joinpoint regression software to analyse the trends. RESULTS The quality of antimicrobial prescribing improved markedly, and the inappropriate treatment rate was significantly lower, with quarterly percentage change (QPC) = -3.0%, p < 0.001. Total antimicrobial consumption decreased (QPC = -0.9%, p < 0.001), specifically carbapenems, amoxicillin/clavulanic acid, quinolones and antifungal agents, whereas antipseudomonal cephalosporin use increased. While the incidence of MDR showed a sustained decreasing trend (QPC = -1.8%; p 0.002), the mortality of patients with bloodstream infections remained stable (QPC = -0.2%, p 0.605). CONCLUSIONS To date, the PIRASOA programme has succeeded in optimizing the use of antimicrobial agents and has had a positive ecologic result on bacterial resistance at level of an entire healthcare system.

中文翻译：

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PIRASOA计划的成果，这是在西班牙安达卢西亚公共卫生系统的医院中实施的抗菌管理计划：时间趋势分析的生态研究。

目的不当使用抗菌药物会促进耐药性的传播，目前，耐多药微生物（MDR）引起了人们的极大关注。抗菌素管理计划（ASPs）对于改善医院中的抗生素使用至关重要。但是，它们对整个医疗系统的影响尚未得到彻底评估。我们的目标是提供由西班牙安达卢西亚的31家公立医院提供机构支持的ASP的结果。方法我们设计了2014年1月1日至2017年12月31日的生态时间序列研究。每季度一次，前瞻性地收集指标数据，并提供反馈报告。PIRASOA是一项正在进行的基于临床的质量改进计划，其主要干预措施是教育性访谈，顾问和开药者之间定期进行点对点干预，以加强抗生素的适当使用。监测了72个指标，以测量处方质量（不适当的治疗），抗菌药物的消耗（定义为每1000个就诊日的每日剂量），每1000个就诊日的MDR发生密度以及与血流感染相关的粗死亡率。我们使用Joinpoint回归软件来分析趋势。结果抗菌处方的质量显着改善，不适当的治疗率显着降低，季度百分比变化（QPC）= -3.0％，p <0.001。抗菌药物的总消费量下降了（QPC = -0.9％，p <0.001），特别是碳青霉烯类，阿莫西林/克拉维酸，喹诺酮类和抗真菌剂，而抗假性头孢菌素的使用增加。尽管MDR的发病率呈现持续下降的趋势（QPC = -1.8％； P = 0.002），但血液感染患者的死亡率仍保持稳定（QPC = -0.2％，P = 0.605）。结论迄今为止，PIRASOA计划已成功优化了抗菌剂的使用，并且在整个医疗体系中对细菌耐药性产生了积极的生态结果。