Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes
Journal
Infection Control & Hospital Epidemiology
ISSN
0899-823X
1559-6834
Date Issued
2021
Author(s)
Rodolfo E. Quirós
Ana C. Bardossy
Patricia Angeleri
Jeannete Zurita
Washington R. Aleman Espinoza
Marcelo Carneiro
Silvia Guerra
Julio Medina
Ximena Castañeda Luquerna
Alexander Guerra
Silvio Vega
Luis E. Cuellar Ponce de Leon
Elvio D. Escobar
Gina Maki
Tyler Prentiss
Marcus Zervos
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:title>Abstract</jats:title><jats:sec id="S0899823X21000805_as1"><jats:title>Objective:</jats:title><jats:p>To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical–surgical intensive care units (MS-ICUs) in Latin America.</jats:p></jats:sec><jats:sec id="S0899823X21000805_as2"><jats:title>Design:</jats:title><jats:p>Quasi-experimental prospective with continuous time series.</jats:p></jats:sec><jats:sec id="S0899823X21000805_as3"><jats:title>Setting:</jats:title><jats:p>The study included 77 MS-ICUs in 9 Latin American countries.</jats:p></jats:sec><jats:sec id="S0899823X21000805_as4"><jats:title>Patients:</jats:title><jats:p>Adult patients admitted to an MS-ICU for at least 24 hours were included in the study.</jats:p></jats:sec><jats:sec id="S0899823X21000805_as5"><jats:title>Methods:</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec id="S0899823X21000805_as6"><jats:title>Results:</jats:title><jats:p>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; <jats:italic>P</jats:italic> < .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; <jats:italic>P</jats:italic> < .0001), adherence to clinical guidelines (92.5% vs 59.3%; <jats:italic>P</jats:italic> < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; <jats:italic>P</jats:italic> < .0001), crude mortality (15.9% vs 17.7%; <jats:italic>P</jats:italic> < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; <jats:italic>P</jats:italic> = .004).</jats:p></jats:sec><jats:sec id="S0899823X21000805_as7"><jats:title>Conclusion:</jats:title><jats:p>MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.</jats:p></jats:sec>
Cite this document
Quirós, R. E., Bardossy, A. C., Angeleri, P., Zurita, J., Aleman Espinoza, W. R., Carneiro, M., Guerra, S., Medina, J., Castañeda Luquerna, X., Guerra, A., Vega, S., Cuellar Ponce De Leon, L. E., Munita, J., Escobar, E. D., Maki, G., Prentiss, T., Zervos, M., & for the PROA-LATAM Project Group. (2022). Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes. Infection Control & Hospital Epidemiology, 43(2), 181-190. https://doi.org/10.1017/ice.2021.80
Subjects
infectious-diseases society
;
antibiotic use
;
epidemiology
;
hospitals
;
risk
;
guidelines
;
fluoroquinolones
;
adult
;
anti-bacterial agents
;
antimicrobial stewardship
;
humans
;
intensive care units
;
latin america
;
prospective studies
;
aminoglycoside antibiotic agent
;
amoxicillin
;
antifungal agent
;
antiinfective agent
;
beta lactamase inhibitor
;
carbapenem
;
carbapenem derivative
;
cephalosporin
;
chlorhexidine
;
meropenem
;
penicillin derivative
;
piperacillin
;
polymyxin
;
polypeptide antibiotic agent
;
vancomycin
;
antiinfective agent
;
acinetobacter
;
antibiotic prophylaxis
;
antibiotic resistance
;
antibiotic therapy
;
antimicrobial stewardship
;
argentina
;
article
;
bolivia
;
brazil
;
carbapenem resistant pseudomonas aeruginosa
;
carbapenem-resistant enterobacteriaceae
;
catheter infection
;
chile
;
clostridium difficile infection
;
colombia
;
community acquired infection
;
crude mortality rate
;
drug utilization
;
ecuador
;
extended spectrum beta lactamase producing enterobacteriaceae
;
hand washing
;
health program
;
healthcare associated infection
;
human
;
major clinical study
;
medical intensive care unit
;
methicillin resistant staphylococcus aureus
;
multicenter study
;
multidrug resistance
;
multidrug resistant bacterium
;
nonhuman
;
outcome assessment
;
panama
;
peru
;
pharmacist
;
practice guideline
;
prescription
;
program appropriateness
;
prospective study
;
protocol compliance
;
quasi experimental study
;
self evaluation
;
south and central america
;
surgical intensive care unit
;
time series analysis
;
urinary tract infection
;
uruguay
;
vancomycin resistant enterococcus
;
ventilator associated pneumonia
;
adult
;
clinical trial
;
intensive care unit
;
south and central america