Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes

Abstract

Objective: To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical–surgical intensive care units (MS-ICUs) in Latin America. Design: Quasi-experimental prospective with continuous time series. Setting: The study included 77 MS-ICUs in 9 Latin American countries. Patients: Adult patients admitted to an MS-ICU for at least 24 hours were included in the study. Methods: This multicenter study was conducted over 12 months. To evaluate the ASPs, representatives from all MS-ICUs performed a self-assessment survey (0–100 scale) at the beginning and end of the study. The impact of each ASP was evaluated monthly using the following measures: antimicrobial consumption, appropriateness of antimicrobial treatments, crude mortality, and multidrug-resistant microorganisms in healthcare-associated infections (MDRO-HAIs). Using final stewardship program quality self-assessment scores, MS-ICUs were stratified and compared among 3 groups: ≤25th percentile, >25th to <75th percentile, and ≥75th percentile. Results: In total, 77 MS-ICU from 9 Latin American countries completed the study. Twenty MS-ICUs reached at least the 75th percentile at the end of the study in comparison with the same number who remain within the 25th percentile (score, 76.1 ± 7.5 vs 28.0 ± 7.3; P < .0001). Several indicators performed better in the MS-ICUs in the 75th versus 25th percentiles: antimicrobial consumption (143.4 vs 159.4 DDD per 100 patient days; P < .0001), adherence to clinical guidelines (92.5% vs 59.3%; P < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; P < .0001), crude mortality (15.9% vs 17.7%; P < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; P = .004). Conclusion: MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.

The Healthcare Professionals’ Perspectives on Antimicrobial Resistance (AMR) Associated Factors and Their Consequences: A Cross Sectional Study in Eastern Province of Saudi Arabia

“…concluded that antimicrobial stewardship programs (ASPs) helped to reduce the use of antifungals in hospitalized patients and highlighted the importance of promoting antifungal stewardship among antibiotic stewardship [20]. Also, Rodolfo E. Quirós et al showed significant improvement in antimicrobial utilization after multiple and intensive ASPs [3] . Interestingly, targeting antimicrobial therapy to likely pathogens was not mostly considered a factor that may help control AMR.…”

“…Antimicrobial agents have the advantage of treating infectious diseases, and they have the potential not only to retain the quality of life of the patient but have also proved to be lifesaving in a variety of severe infectious conditions [1]. Improper use of antimicrobials has led to the development of antimicrobial resistant (AMR), which has been associated with failure in managing infections, increased in length of hospital stay, increased mortality, morbidity [2,3] , and health costs [4,5 ]. Several factors have been described in the literature to be correlated with inappropriate prescribing of antimicrobials, such as physicians with less experience, level of knowledge, uncertain diagnosis, and patient caregiver influences on physician's decision [6].…”

Impact of a pharmacist‐driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: A retrospective study

“…11,32 Vancomycin is an agent that must be handled correctly due to the high rates of methicillin-resistant S aureus infections in the area. 12 Ertapenem presented one of the most significant improvements in its empirical use. This behavior can also respond to the attention that has been given to promoting the reduction of the unnecessary use of this antibiotic within the hospital through the different group educational sessions developed.…”

“…10 An example of such a practice is known as "Handshake Stewardship" (HS), characterized by having no antibiotic restrictions or prior authorizations, but a daily prescription monitorization, and having direct communication with physicians. 11 Implementing AMS in Latin America has been challenging, because of strong opposition by prescribers, 12,13 limited resources, 14 which may include, a lack of financial support from hospital administrators, lack of information and technology development, 12 and the need for adequate trained hospital staff in infectious diseases, such as nurses and pharmacists, especially infectious diseases clinical pharmacists. 3,13 Hospital Clínica Bíblica is one of the leading private hospitals in Costa Rica and Latin America, where the development of clinical pharmacy initiatives within the hospital, has proven not to be only a key element for patient safety and clinical outcomes, but also a contribution to the development of clinical pharmacy in the country.…”

Antibiotic Consumption and Its Relationship with Bacterial Resistance Profiles in ESKAPE Pathogens in a Peruvian Hospital

“…Bacterial resistance represents a serious problem in Peru because over 50% of Gramnegative bacteria isolated are Escherichia coli and Klebsiella pneumoniae ESBL across different hospitalization areas, including general rooms, emergency rooms and intensive care units [13]. In response to the antimicrobial resistance challenge, some Peruvian hospitals have started the implementation of antimicrobial stewardship (AMS) programs in order to reduce the consumption of broad-spectrum antibiotics [13,14]. These response strategies include antimicrobial restriction, educational campaigns and promotion of antimicrobial profiles and algorithms, prospective audit, pre-authorized forms and monitoring empirical antimicrobial treatment flowcharts elaborated in consensus with the intensive care, infection control, pharmacy and microbiology units [13].…”