%0 Journal Article
%T Antimicrobial stewardship through telemedicine and its impact on multi
%A Camila H Dalmora
%A Caroline Deutschendorf
%A Marcelo V Gambetta
%A Nilson C Correa
%A Ot¨¢vio Carvalho
%A Raquel Lima
%A Rodrigo P dos Santos
%A Stephani A Lukasewicz
%A Tiago Leitzke
%J Journal of Telemedicine and Telecare
%@ 1758-1109
%D 2019
%R 10.1177/1357633X18767702
%X Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, ¦Â£¿=£¿£¿0.80; P£¿<£¿0.01; trend change, ¦Â£¿=£¿£¿0.01; P£¿=£¿0.98), first-generation cephalosporins (level change, ¦Â£¿=£¿£¿0.91; P£¿<£¿0.01; trend change, ¦Â£¿=£¿+0.01; P£¿=£¿0.96), vancomycin (level change, ¦Â£¿=£¿£¿0.47; P£¿=£¿0.04; trend change, ¦Â£¿=£¿+0.17; P£¿=£¿0.66) and polymyxins (level change, ¦Â£¿=£¿£¿0.15; P£¿=£¿0.56; trend change, ¦Â£¿=£¿£¿1.75; P£¿<£¿0.01) were identified. There was an increase in the consumption of amoxicillin£¿+£¿clavulanate (level change, ¦Â£¿=£¿+0.84; P£¿<£¿0.01; trend change, ¦Â£¿=£¿+0.14; P£¿=£¿0.41) and cefuroxime (level change, ¦Â£¿=£¿+0.21; P£¿=£¿0.17; trend change, ¦Â£¿=£¿+0.66; P£¿=£¿0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, ¦Â£¿=£¿+0.66; P£¿=£¿0.01; trend change, ¦Â£¿=£¿£¿1.26; P£¿<£¿0.01) was observed. Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance
%K Antimicrobial stewardship
%K telemedicine
%K bacterial resistance
%U https://journals.sagepub.com/doi/full/10.1177/1357633X18767702