Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study


Autoři: Nonke E. M. Hopman aff001;  Lützen Portengen aff002;  Marlies E. J. L. Hulscher aff003;  Dick J. J. Heederik aff002;  T. J. M. Verheij aff004;  Jaap A. Wagenaar aff001;  Jan M. Prins aff006;  Tjerk Bosje aff007;  Louska Schipper aff002;  Ingeborg M. van Geijlswijk aff002;  Els M. Broens aff001
Působiště autorů: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands aff001;  Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands aff002;  Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands aff003;  Julius Center for Health Sciences and Primary care, University Medical Center, Utrecht, the Netherlands aff004;  Wageningen Bioveterinary Research, Lelystad, the Netherlands aff005;  Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands aff006;  Medical Center for Animals, Amsterdam, the Netherlands aff007;  Pharmacy Department, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands aff008
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225124

Souhrn

Background

To curb increasing resistance rates, responsible antimicrobial use (AMU) is needed, both in human and veterinary medicine. In human healthcare, antimicrobial stewardship programmes (ASPs) have been implemented worldwide to improve appropriate AMU. No ASPs have been developed for and implemented in companion animal clinics yet.

Objectives

The objective of the present study was to implement and evaluate the effectiveness of an ASP in 44 Dutch companion animal clinics. The objectives of the ASP were to increase awareness on AMU, to decrease total AMU whenever possible and to shift AMU towards 1st choice antimicrobials, according to Dutch guidelines on veterinary AMU.

Methods

The study was designed as a prospective, stepped-wedge, intervention study, which was performed from March 2016 until March 2018. The multifaceted intervention was developed using previous qualitative and quantitative research on current prescribing behaviour in Dutch companion animal clinics. The number of Defined Daily Doses for Animal (DDDAs) per clinic (total, 1st, 2nd and 3rd choice AMU) was used to quantify systemic AMU. Monthly AMU data were described using a mixed effect time series model with auto-regression. The effect of the ASP was modelled using a step function and a change in the (linear) time trend.

Results

A statistically significant decrease of 15% (7%-22%) in total AMU, 15% (5%-24%) in 1st choice AMU and 26% (17%-34%) in 2nd choice AMU was attributed to participation in the ASP, on top of the already ongoing time trends. Use of 3rd choice AMs did not significantly decrease by participation in the ASP. The change in total AMU became more prominent over time, with a 16% (4%-26%) decrease in (linear) time trend per year.

Conclusions

This study shows that, although AMU in Dutch companion animal clinics was already decreasing and changing, AMU could be further optimised by participation in an antimicrobial stewardship programme.

Klíčová slova:

Antimicrobial resistance – Antimicrobials – Behavior – Decision making – Pets and companion animals – Veterinarians – Veterinary medicine – Small animal care


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Článek vyšel v časopise

PLOS One


2019 Číslo 11