Current Status of Antimicrobial Stewardship Programs in São Paulo Hospitals

Abstract

Antimicrobial stewardship programs (ASPs) comprise coordinated interventions designed to improve antimicrobial use. Understanding the current structure of ASP hospitals will support interventions for the improvement of these programs. This study aimed to describe the status of ASPs in hospitals in Sã o Paulo, Brazil. METHODS: A cross-sectional survey was conducted on the ASPs of hospitals in the state of Sã o Paulo from March to July 2018. Through interviews by telephone or e-mail, we queried which components of the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America and Centers for Disease Control and Prevention guidelines were implemented. RESULTS: The response rate was 30% (28/93 hospitals), and 26 hospitals (85%) reported having a formal ASP. The most frequently implemented strategies were antimicrobial surgical prophylaxis guidelines (100%), empiric sepsis guidelines (93%), and the presence of ASP team members during bedside rounds (96%). The least commonly implemented strategies included prior authorization for all antimicrobials (11%), pharmacokinetic monitoring, and an adjustment program for patients on IV aminoglycosides (3%). Regarding the metrics of the ASP, the most common indicator was the rate of antimicrobial resistance (77%). Eighteen hospitals evaluated antimicrobial consumption using defined daily dose, and only 29% evaluated the days of therapy; 61% of hospitals reported their results to the hospital administration and 39% to the prescribers. CONCLUSIONS: Most hospitals have a formal and active ASP, but with timely actions. We observed inconsistencies between what program leaders understand as the main objective of ASP and the metrics used to evaluate it. Part of the effort for the next few years should be to improve program evaluation metrics and to provide feedback to physicians and hospital leadership.

Brazilian perspective: antimicrobial stewardship in solid organ transplant

“…In Brazil, pharmacists with experience in infectious diseases are generally not uniformly present in hospitals. In São Paulo, only 59% of the evaluated ASPs had a pharmacist on the team 20 …”

“…Sato et al. evaluated a sample of 28 ASPs in hospitals in the state of São Paulo and found that 100% had antibiotic therapy and surgical prophylaxis guidelines, Clostridioides difficile diagnose, and antifungal usage, but with highly variable face‐to‐face auditing, consumption data, and feedback strategies 20 …”

“…In São Paulo, only 59% of the evaluated ASPs had a pharmacist on the team. 20 Sato et al evaluated a sample of 28 ASPs in hospitals in the state of São Paulo and found that 100% had antibiotic therapy and surgical prophylaxis guidelines, Clostridioides difficile diagnose, and antifungal usage, but with highly variable face-to-face auditing, consumption data, and feedback strategies. 20 Although there has been progress in infection control practices, surgical site infections (SSIs) remain one of the most common healthcareassociated infections.…”

“…20 Sato et al evaluated a sample of 28 ASPs in hospitals in the state of São Paulo and found that 100% had antibiotic therapy and surgical prophylaxis guidelines, Clostridioides difficile diagnose, and antifungal usage, but with highly variable face-to-face auditing, consumption data, and feedback strategies. 20 Although there has been progress in infection control practices, surgical site infections (SSIs) remain one of the most common healthcareassociated infections. SSIs are a significant issue in transplant recipients with higher rates of SSIs among SOT recipients than among non-SOT recipients who undergo comparable clean or clean-contaminated procedures.…”

Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective

“…Most studies describing the process of ASP implementation in hospitals and the assessment of its performance over time have been developed in high-income countries ( Cox et al, 2017 ). There are few studies discussing the experience of ASP implementation in low- and middle-income countries, such as Brazil ( Bizerra, 2020 ; Sato et al, 2021 ; Menezes et al, 2022 ), as well as the methods for program evaluation and feedback to healthcare teams and hospital leadership. Thus, the aim of this study was to describe the ASP implementation in a teaching hospital from the Donabedian perspective and the Brazilian regulatory requirements, assessing the structure, work processes and the evaluation metrics monitored over six years.…”