Impact of A Mobile App For Antibiotic Stewardship on The Incidence of Nosocomial Infections With Multidrug Resistant Micro Organisms

The Incidence Infections With Multidrug Resistant Micro Organisms. Abstract Objectives: to determine the impact of a guideline for empiric antimicrobial based on local data of microorganism resistance delivered via mobile app as a strategy of an antibiotic stewardship program on the incidence of nosocomial infections and isolation of multidrug resistant microorganisms.

Similarly, in the intensive care units of the same network, there was an increase of isolates of Acinetobacter baumannii from 4% in 1986 to 7% in 2003, with a significant increase in resistance profiles, as well as an increase of isolates of imipenem and ceftazidime resistant Pseudomonas aeruginosa and ESBL Escherichia coli [3].
In Mexico, the same trend towards increase in bacterial resistance has been reported, for example, one study group reported that Acinetobacter baumannii meropenem-sensitive decreased from 92% in 1999 to 12% in 2012 [4]. According to data from the Hospitalary Network of Epidemiological Vigilance (RHOVE) in 2015, there was an increase in isolates of ESBL Escherichia coli, Klebsiella pneumoniae y Enterobacter cloacae, as well as imipenem and quinolone resistant Pseudomonas aeruginosa, Clostridioides difficile and Acinetobacter baumannii. The lethality rate increased from 4.8% deaths in 2014 to 5.8% deaths in 2015 [5].
Rationale for rise in microorganism resistance is variable, depending on geographical situation and specific agents. However, the selective pressure secondary to indiscriminate antibiotic use that, in Mexico, could be purchased without medical prescription until 2010, inadecuate infection control practices, increase in the amount of vulnerable patients associated to longer survival in chronic disease and disease associated with immunosupression, antibiotic use in agriculture and farming industry for human consumption and globalization are some factors associated with increase in bacterial resistance [6]. Infections with multi-drugresistant bacteria are associated with increase in hospitalization lenght, need of surgery to achieve infection control, delay in starting adecuate antimicrobial therapy, the need for antimicrobial agents with greater toxicity and rise in moribidity and mortality, that lead to higher health expenditure. In the United States of America the estimated total cost of antimicrobial resistance is 30 billion dollars a year [7].
In Spain, a retrospective study reported a higher all-cause mortality rate in individuals with nosocomial infections caused by MDR bacteria (OR 2.17) and a higher ammount of emergency room visits for patients infected by MRSA and resistant strains of Escherichia coli; there was no rise in time of hospital stay, need for admission in general ward or intensive care unit, need for surgery or diagnostic tests, however, individuals infected with more than one multidrug-resistant microorganism and the ones with two or more episodes of infection during hospital stay where excluded [8]. Additionally, in low income countries, the access to certain antimicrobial drugs is limited by availability and cost. Antibiotic stewardship programs intent to reduce incidence of infections caused by MDR microorganism in healthcare facilities. The goals are antimicrobial drug use optimization, to reduce adverse effects and, ultimately, decrease mortality. Implementation of these programs proved to be associated with a decrease in isolates of resistant bacteria with adequeate adherence to recommendations.
A study developed in Andalucia, Spain showed a 10% reduction in imipenem resistant Pseudomonas aeruginosa and a 13% decrease in ESBL Klebsiella pneumoniae, with a healthcare expenditure saving of 30,000 euro annually [9]. Other studies have similar findings, with decrease in incidence of MDR bacteria, Clostridioides difficile and also a decrease in antimicrobial defined daily dose [10][11][12][13][14][15]. The objective of this study was to determine the impact of a guidelines for empiric antimicrobial treatment delivered via mobile app, as a strategy of an antimicrobial stewardship program introduced in 2013 in the incidence of nosocomial infections and isolation of MDR microorganisms in a tertiary referral hospital in Mexico city.

Materials and Methods
Retrospective, observational, unicentric study developed in Medica Sur, a tertiary referral private hospital in Mexico city.

Discussion
Antimicrobial abuse generates selection pressure associated with the development of bacteria strain profiles with multiple drug resistance and some studies have shown that, in as much as 30-50% of cases, empirical antimicrobial selection of therapy, indication of treatment or duration are inadequate [14]. The development of resistant bacteria strains is already considered a public health issue that, in the United States, affects 2 million people of whom 23 000 die each year [15]. This study assessed the impact on bacterial resistance in our healthcare facility after implementation of local