Outcomes of the PIRASOA programme, an antimicrobial stewardship programme implemented in hospitals of the public Health system of Andalusia, Spain: an ecological study of time-trend analysis

Abstract 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 is to provide the results of an institutionally supported ASP involving 31 public hospitals in Andalusia, Spain. Methods We designed an ecological time-series study from 01/01/2014 to 31/12/2017. 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. 72 indicators were monitored to measure prescribing quality (inappropriate treatments), antimicrobial consumption (defined daily doses/1000 occupied bed days [OBD]), incidence density of MDR/1000 OBD, and crude mortality rate associated with bloodstream infections. We used joinpoint regression to analyse the trends. Results The quality of antimicrobial prescribing improved markedly and inappropriate treatment rate was significantly lower with quarterly percentage change (QPC)=-3.0%, P P P =.002), the mortality of patients with bloodstream infections remained stable (QPC=-0.2%, P =.605). Conclusions To date, the PIRASOA programme has succeeded in optimising the use of antimicrobial agents and has had a positive ecological result on bacterial resistance at level of an entire healthcare system.