Effectiveness of Antimicrobial Stewardship Programmes in Reducing Hospital-Acquired Multidrug-Resistant Bacterial Infections: A Multicentre Cohort Study
DOI:
https://doi.org/10.66687/3kywqe40Keywords:
antimicrobial stewardship, multidrug resistance, hospital-acquired infection, cohort study, antibiotic utilisation, competing risksAbstract
Background: Antimicrobial stewardship programmes (ASPs) seek to improve antibiotic prescribing and reduce selection pressure for multidrug-resistant organisms (MDROs). Whether patient-level exposure to ASP care is independently associated with fewer hospital-acquired multidrug-resistant infections remains uncertain.
Methods: We analysed an 800-patient observational cohort from eight anonymised hospitals in the United States, conducted from January to December 2022. Patients receiving ASP-managed care (n=433) were compared with usual care (n=367) at a 48-hour hospital landmark. The primary endpoint was first new hospital-acquired multidrug-resistant bacterial infection before discharge, inpatient death or day 30. Cause-specific Cox regression was stratified by hospital and adjusted for demographics, comorbidity, severity, device exposure, recent antibiotic use, known colonisation, immunosuppression and baseline ward hand-hygiene compliance. Discharge and inpatient death were treated as competing events in descriptive cumulative-incidence analyses.
Results: New resistant infections occurred in 69/433 ASP-managed patients (15.9%) and 83/367 usual-care patients (22.6%); crude risk ratio 0.70 (95% confidence interval [CI] 0.53–0.94). The adjusted cause-specific hazard ratio was 0.68 (95% CI 0.40–1.13; P=0.138). Baseline hand-hygiene compliance was substantially higher in ASP wards (86.4% versus 66.0%). ASP management was associated with fewer broad-spectrum antibiotic days (adjusted geometric mean ratio 0.84, 95% CI 0.76–0.92), but no clear difference in 30-day mortality (adjusted odds ratio 1.21, 95% CI 0.40–3.69).
Conclusions: ASP-managed care was associated with a lower unadjusted occurrence of new hospital-acquired resistant infections and reduced broad-spectrum antibiotic exposure. The primary association was uncertain after adjustment, particularly given marked differences in ward infection-prevention context. Randomised or well-controlled longitudinal studies are needed to distinguish stewardship effects from concurrent infection-control improvements.
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