Prescription of antibiotics in intensive care units in Latin America: an observational study

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Antimicrobial Stewardship

Background:

• Antibiotic resistance is a growing global health threat, particularly in intensive care units (ICUs).
• Latin America faces significant challenges with multidrug-resistant (MDR) pathogens, yet patterns of antibiotic use in its ICUs are not well-characterized.

Purpose of the Study:

• To investigate the patterns of antibiotic prescribing in Latin American ICUs.
• To identify associations between antibiotic use, infection types, and patient severity.
• To explore the contribution of current practices to the prevalence of antimicrobial resistance.

Main Methods:

• A one-day point prevalence study was conducted across 43 ICUs in Latin America.
• Data collected included patient demographics, infection status, cultures performed, and antibiotics administered.
• Patient severity was assessed using APACHE II and SOFA scores.

Main Results:

• Antibiotics were used in 45% of 510 ICU patients, primarily for hospital-acquired infections (54%), with nosocomial pneumonia being most common (43%).
• Cultures were performed before antibiotic initiation in only 53% of cases. Common pathogens included extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (33%), methicillin-resistant Staphylococcus aureus (23%), and carbapenem-resistant Gram-negatives (17%).
• Carbapenems were the most frequent antibiotic class (43%), often used empirically. "Restricted" antibiotics were more common in severely ill patients. Only 36% of treatments were guided by culture results.

Conclusions:

• High rates of antibiotic use, particularly broad-spectrum agents, and low rates of culture-directed therapy in Latin American ICUs likely contribute to the prevalence of MDR pathogens.
• These prescribing patterns may exacerbate the challenge of managing severe infections and antimicrobial resistance in the region.