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Abstract：
Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. However, their effectiveness or safety in immunocompromised hosts needs to be proved.
An ecologic quasi-experimental study was performed from January 2009 to June 2017 in the Oncology department of a tertiary-care hospital. A stable program of Infectious Diseases consultation (IDC) already existed at this unit, and an educational ASP was added in 2011. Its main intervention consisted of face-to-face educational interviews. Antibiotic consumption was assessed through quarterly Defined Daily Doses (DDD) per 100 occupied bed-days. Mortality was evaluated in patients with bloodstream infections through the quarterly incidence density per 1000 admissions, and the annual mortality rates at 7 and 30-days. Time-trends were analysed through segmented-regression analysis, and the impact of the ASP was assessed through before-after interrupted time-series analysis.
Mortality significantly decreased throughout the study period (-13.3% annual reduction for 7-day mortality rate, p < 0.01; -8.1% annual reduction for 30-day mortality, p = 0.03), parallel to a reduction in antibiotic consumption (quarterly reduction -0.4%, p = 0.01), especially for broader-spectrum antibiotics. The before-after study settled a significant inflexion point on the ASP implementation for the reduction of antibiotic consumption (change in level 0.95 DDD, p = 0.71; change in slope -1.98 DDD per quarter, p < 0.01). The decreasing trend for mortality before the ASP also continued after its implementation.
The combination of an ASP with IDC improved antibiotic use among patients with cancer, and was accompanied by a reduction of mortality of bacteraemic infections. Implementation of the ASP was necessary to effectively change antibiotic use.
An ecologic quasi-experimental study was performed from January 2009 to June 2017 in the Oncology department of a tertiary-care hospital. A stable program of Infectious Diseases consultation (IDC) already existed at this unit, and an educational ASP was added in 2011. Its main intervention consisted of face-to-face educational interviews. Antibiotic consumption was assessed through quarterly Defined Daily Doses (DDD) per 100 occupied bed-days. Mortality was evaluated in patients with bloodstream infections through the quarterly incidence density per 1000 admissions, and the annual mortality rates at 7 and 30-days. Time-trends were analysed through segmented-regression analysis, and the impact of the ASP was assessed through before-after interrupted time-series analysis.
Mortality significantly decreased throughout the study period (-13.3% annual reduction for 7-day mortality rate, p < 0.01; -8.1% annual reduction for 30-day mortality, p = 0.03), parallel to a reduction in antibiotic consumption (quarterly reduction -0.4%, p = 0.01), especially for broader-spectrum antibiotics. The before-after study settled a significant inflexion point on the ASP implementation for the reduction of antibiotic consumption (change in level 0.95 DDD, p = 0.71; change in slope -1.98 DDD per quarter, p < 0.01). The decreasing trend for mortality before the ASP also continued after its implementation.
The combination of an ASP with IDC improved antibiotic use among patients with cancer, and was accompanied by a reduction of mortality of bacteraemic infections. Implementation of the ASP was necessary to effectively change antibiotic use.
摘要：
抗生素管理计划（ASP）已经证明了临床益处。然而,它们在免疫受损宿主中的有效性或安全性需要得到证实.
2009年1月至2017年6月，在一家三级医院的肿瘤科进行了一项生态准实验研究。该单位已经存在稳定的传染病咨询（IDC）计划，2011年增加了教育ASP。其主要干预包括面对面的教育访谈。通过每100个占用床日的季度定义的每日剂量(DDD)评估抗生素消耗。通过每1000例入院的季度发病率密度评估血流感染患者的死亡率。以及7天和30天的年死亡率。时间趋势通过分段回归分析进行分析，并通过前后中断时间序列分析评估ASP的影响。
在整个研究期间，死亡率显着下降（7天死亡率每年降低13.3％，p<0.01；30天死亡率每年降低8.1%，p=0.03),与抗生素消费量减少(季度减少-0.4%，p=0.01),尤其是广谱抗生素.前后研究解决了ASP实施以减少抗生素消耗的显着拐点（0.95DDD水平的变化，p=0.71；每季度斜率变化-1.98DDD，p<0.01)。ASP实施后，死亡率下降的趋势也在继续。
ASP与IDC的结合改善了癌症患者的抗生素使用，并伴随着细菌感染死亡率的降低。ASP的实施对于有效改变抗生素的使用是必要的。
2009年1月至2017年6月，在一家三级医院的肿瘤科进行了一项生态准实验研究。该单位已经存在稳定的传染病咨询（IDC）计划，2011年增加了教育ASP。其主要干预包括面对面的教育访谈。通过每100个占用床日的季度定义的每日剂量(DDD)评估抗生素消耗。通过每1000例入院的季度发病率密度评估血流感染患者的死亡率。以及7天和30天的年死亡率。时间趋势通过分段回归分析进行分析，并通过前后中断时间序列分析评估ASP的影响。
在整个研究期间，死亡率显着下降（7天死亡率每年降低13.3％，p<0.01；30天死亡率每年降低8.1%，p=0.03),与抗生素消费量减少(季度减少-0.4%，p=0.01),尤其是广谱抗生素.前后研究解决了ASP实施以减少抗生素消耗的显着拐点（0.95DDD水平的变化，p=0.71；每季度斜率变化-1.98DDD，p<0.01)。ASP实施后，死亡率下降的趋势也在继续。
ASP与IDC的结合改善了癌症患者的抗生素使用，并伴随着细菌感染死亡率的降低。ASP的实施对于有效改变抗生素的使用是必要的。
