Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes
Date
2021
Type:
Article
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Abstract
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.
Description
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Citation
Quirós RE, Bardossy AC, Angeleri P, Zurita J, Aleman Espinoza WR, Carneiro M, Guerra S, Medina J, Castañeda Luquerna X, Guerra A, Vega S, Cuellar Ponce de Leon LE, Munita J, Escobar ED, Maki G, Prentiss T, Zervos M; PROA-LATAM Project Group. Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes. Infect Control Hosp Epidemiol. 2021 Apr 8:1-10. doi:10.1017/ice.2021.80
Keywords
Anti-Bacterial Agents / administration & dosage, Anti-Bacterial Agents / therapeutic use, Anti-Infective Agents / administration & dosage, Anti-Infective Agents / therapeutic use, Antimicrobial Stewardship / methods, Cross Infection / epidemiology, Intensive Care Units / statistics & numerical data, Longitudinal Studies, Middle Aged, Treatment Outcome, Antimicrobial