Objectives. To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting. Methods. This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included ‘antibiotic’ or ‘antimicrobial’ AND ‘stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions’ and 33 country names. Results. Selected articles totalled 147 studies published in 1985 – 2019; of those, 22% used ‘antimicrobial stewardship’ in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements. Conclusions. Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.
Background One of the aims of antimicrobial stewardship programs (ASP) in hospitals is to make an efficient use of the available infrastructure to enhance surveillance and antimicrobial resistance (AMR) reporting. In this study, we aimed to explore specific AMR reporting mechanisms in ASPs in Mexican hospitals in order to highlight potential areas of improvement. Methods An online survey was applied to a purposive sample of 40 hospitals who performed regular antimicrobial stewardship activities in Mexico. Answers regarding a subset of questions on antimicrobial susceptibility monitoring and reporting practices were provided by ASP professionals. Results A total of 39 hospitals (14 private and 25 public hospitals) in 13 states in Mexico answered the subset of the survey. Thirty-three of those (85%) expressed that their databases allowed periodically monitoring of changes in susceptibility and resistance patterns for specific pathogens. As many as 17 hospitals (44%) reported to two external national academic networks and none reported to international ones. Only 10 reported to the National Hospital Network for Epidemiological Surveillance (RHOVE) in charge of AMR data (29%). Thirty hospitals (77%) declared reporting their AMR consolidated results internally to either the epidemiology department, an ASP leader, or other hospital committee. Twenty percent of the surveyed hospitals issued AMR reports to two entities, an additional 10% of them to 3 entities and 5% more to 4 different entities; reporting to >3 entities was observed only in public hospitals. Two hospitals (5%) declared not submitting AMR reports at all. Conclusion The adoption of reporting commitments without guiding national AMR policies derives into the duplicity of processes (reporting to different networks or entities) requiring additional human and financial resources. It also reflects the unavailability of a functional national reporting system allowing all hospitals to monitor and access the reported information nationally or internationally (GLASS). Optimizing AMR surveillance and reporting in Mexico must incorporate the simplification and standardization of reporting processes into an articulated system in line with the National Strategy against AMR. Disclosures Anahí Dreser, PhD, MSD: Grant/Research Support.
Background The development of antimicrobial stewardship programs (ASP) can help to improve the quality of care and contain the growing problem of antimicrobial resistance (AMR). In Mexico, there is little evidence on the design, implementation and evaluation of hospital ASP. The objective of this study is to present a situational diagnosis of the ASP structure, processes implemented and monitoring of results obtained in a sample of Mexican hospitals. Methods An online survey directed to ASP teams was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021. The survey was based on the ‘core elements’ instruments developed by the CDC and WHO. Results Forty hospitals (62% public and 38% private) were surveyed in 13 states in Mexico regarding ASP basic elements. Infrastructure and Organization elements: on average 52% of these hospitals carry basic actions that refer to: written ASP document and annual plan (46%); allocated human resources (68%); availability of material resources (59%) and use of technological platforms (37%). Processes: development of hospital treatment guidelines (49%); educational interventions (40%); persuasive and feedback interventions (42%); and in greater proportion, restrictive interventions (77%). Monitoring activities: interventions (25%); antimicrobial consumption (73%) and AMR (85%) Conclusion This first diagnosis serves as a baseline to determine the current state of ASP implementation per hospital and in the country. It also reflects on the ASP heterogeneity, that should be addressed by national policies. The greatest challenge lies in the program governance, and the systematic monitoring of the implementation of ASP interventions. Disclosures Anahí Dreser, PhD, MSD: Grant/Research Support.
Background Hospital antimicrobial stewardship programs (ASP) involve a continuous effort by health institutions to monitor and optimize the use of antimicrobials. In this study, we aimed to explore barriers and opportunities in the implementation of ASP perceived by personnel of Mexican hospitals, as well as their views on the impact of COVID-19 in ASP activities. Methods An online survey was applied to a purposive sample of 40 hospitals that perform regular antimicrobial stewardship activities in Mexico, during the last trimester of 2021. Results A total of 40 hospitals (62.5% public and 37.5% private) in 13 states in Mexico responded to the survey. Regarding the perception of barriers, they identified the overload of activities (73%), hospital reconversion due to COVID-19 (65%), the scarcity of human resources, and resistance of personnel to new procedures (63% each). The main perceived facilitators were the support by hospital authorities (60%) and the commitment by the ASP team and health professionals in the implementation of ASP (48%). Only 15% of hospitals reported that support by health authorities or other hospitals were factors favoring implementation. The main reported changes due to COVID-19 were: temporary suspension of ASP activities (60%); greater workload due to increased prescription of antimicrobials (33%); involvement in interventions (such as education and guidelines) directed to improve antimicrobial use in COVID-19 patients (18%), as well as implementation of new protocols in pharmacy (44%) and microbiology laboratory (51%). 18% reported no changes in ASP. Conclusion Implementation of ASP in Mexican Hospitals could be strengthened by the inclusion of sufficient human resources with protected time for ASP activities, the active involvement of hospital authorities, as well as encouraging the training and leadership of ASP teams. The impact of COVID-19 was two-way: the stagnation of the program in some hospitals, as well as the active participation in the response to the emergency, in other hospitals. Disclosures Anahí Dreser, PhD, MSD: Grant/Research Support.
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