Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis
Authors: Peñalva Germán , Crespo-Rivas Juan Carlos , Guisado-Gil Ana Belén , Rodríguez-Villodres Ángel , Pachón-Ibáñez María Eugenia , Cachero-Alba Bárbara , Rivas-Romero Blas , Gil-Moreno Josefa , Galvá-Borras María Isabel , García-Moreno Mercedes , Salamanca-Bautista María Dolores , Martínez-Rascón Manuel Bautista , Cantudo-Cuenca María Rosa , Ninahuaman-Poma Ruth Concepción , Enrique-Mirón María de los Ángeles , Pérez-Barroso Aurora , Marín-Ariza Inmaculada , González-Florido Miguel , Mora-Santiago María del Rosario , Belda-Rustarazo Susana , Expósito-Tirado José Antonio , Rosso-Fernández Clara María , Gil-Navarro María Victoria , Lepe-Jiménez José Antonio , Cisneros José Miguel ,   the PROA-SENIOR Study Group, Pérez Francisco , Martínez-Ortega Virginia , Palop-Borras Begoña , Fernández-Martín Jesús María , Pradas Francisco , Suárez-Uceda Pedro , Quesada-Sanz Antonio Andrés , López-López María Pilar , Ruiz-Rico María Teresa , Sánchez-García Javier , Jiménez-Páez José María , Luque-Montilla María Rocío , García-Martínez Lucrecia , Egea-Miranda Pilar , Aguilera Francisco José , Amores Carmen , Fernández-Suárez José Manuel , Gutiérrez-Rojas Virginia , Guzmán-González Antonio Francisco , Sánchez-Moral Raquel , Cámara-Mestres Manuel , Domínguez-Jiménez María Carmen , García-Delgado Dulcenombre María , Piedrabuena-Molina José , López-Prieto María Dolores , Vázquez-Vela Victoria , Lázaro Juan Bautista , Cruz-Díaz María Carmen , Medina Rocío , Aller-García Ana Isabel , Sánchez Ana , Cañizares Julio , Lahera Laura , Ramos-Moreno Raquel , Puche Carmen , Villares Gloria , Hurtado Olga , Fernández Fernando , Sánchez-Martínez Cristina , Caballero Josefa , González-López María Carmen , Rodríguez-Maresca Manuel Ángel , Cifuentes-Cabello Susana , Sánchez-Yebra Waldo Eugenio , Ruiz-Antón María Carmen , Figueroa-Molina Mónica , Molina-Cabello José Bernardo , Ferrer-Amate Francisco , Ruiz-Molina Inés , Vilches Francisca , Santaella-Guardiola Yolanda , Ávila-Álvarez José Ramón , Gallego-Galisteo Myriam , Labrador-Herrera Gema , Herrera-Hidalgo Laura , Jiménez-Jorge Silvia 
Published: October 2022

Background

Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs.

Methods

We performed a cluster, randomized, controlled trial and a before–after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD).

Results

The total mean antimicrobial consumption decreased by 31.2% (−16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin–clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (−14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P &lt; .0001).

Conclusions

This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic.

Clinical Trials Registration. NCT03543605.