Reinforcement of an antimicrobial stewardship task force aims at a better use of antibiotics of last resort: the COLITIFOS study

Benjamin Davido; Frédérique Bouchand; Aurélien Dinh; Christian Perronne; Maryvonne Villart; Olivia Senard; Jérome Salomon

doi:10.1016/j.ijantimicag.2017.03.030

Reinforcement of an antimicrobial stewardship task force aims at a better use of antibiotics of last resort: the COLITIFOS study

Int J Antimicrob Agents. 2017 Aug;50(2):142-147. doi: 10.1016/j.ijantimicag.2017.03.030. Epub 2017 Jul 8.

Authors

Benjamin Davido¹, Frédérique Bouchand², Aurélien Dinh³, Christian Perronne³, Maryvonne Villart², Olivia Senard³, Jérome Salomon³

Affiliations

¹ Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches 92380, France. Electronic address: benjamin.davido@aphp.fr.
² Pharmacie hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches 92380, France.
³ Maladies infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, Garches 92380, France.

PMID: 28694232
DOI: 10.1016/j.ijantimicag.2017.03.030

Abstract

Background: Physicians are facing a worldwide increase in multidrug-resistant (MDR) organisms. Eradication of such bacteria, including so called superbugs (XDR), may cause physicians to prescribe last-resort antibiotics. However, experience with these drugs is limited and few data are available.

Methods: A before and after retrospective study was conducted from January 2008 to June 2016. Prescriptions of parenteral antimicrobials considered as last-resort antibiotics (colistin, fosfomycin, tigecycline and temocillin) were reviewed by 4 infectious disease specialists (according to microbiology results, susceptibility testing, clinical situation and alternative agents), while doses were analysed by a pharmacist. As a second step, the cohort was split before and after 2013 coinciding with the arrival of a referent in antimicrobial stewardship.

Results: The treatment of 77 patients with a mean age of 55.4 ± 18.7 years was analysed. The majority were treated for gram-negative rods (69.2%), especially Pseudomonas and Klebsiella spp. and Escherichia coli while 20.0% of patients were treated for gram-positive cocci (mainly Staphylococcus aureus) and the remainder were polymicrobial. Of 84 prescriptions, fosfomycin was the most frequently prescribed (47.6%), followed by colistin (40.5%), tigecycline (10.7%) and temocillin (1.2%). Outcomes were favorable in 75.3% of patients. In patients with MDR and XDR infections (n = 54), the mortality rate was 11.1%. After 2013, there were significantly fewer prescriptions of last-resort antibiotics for susceptible microorganisms (29.2% vs 6.9%), in the absence of supporting microbiology results (22.9% vs 3.5%) and fewer dose errors (56.2% vs 27.6%) (P = 0.02).

Conclusion: Reinforcement of the antimicrobial stewardship task force seems to be valuable for promoting the better use of last-resort antibiotics.

Keywords: Antimicrobial stewardship; Colistin; Fosfomycin; Last-resort antibiotics; Multidrug resistance.

MeSH terms

Adult
Advisory Committees / organization & administration*
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Antimicrobial Stewardship / organization & administration*
Colistin / therapeutic use*
Female
Fosfomycin / therapeutic use*
Gram-Negative Bacterial Infections / drug therapy*
Gram-Positive Bacterial Infections / drug therapy*
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome

Substances

Anti-Bacterial Agents
Fosfomycin
Colistin