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Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and
Rodolfo E Quirós1, Ana C Bardossy2, Patricia Angeleri3
1Clínica Ángel Foianini, Santa Cruz de la Sierra, Bolivia.
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.
Insights
Antimicrobial stewardship programs (ASPs) significantly improved antimicrobial use in Latin American intensive care units. Comprehensive ASPs led to better antimicrobial consumption, adherence, and reduced mortality and infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- Antimicrobial resistance is a growing global health threat.
- Effective antimicrobial stewardship programs (ASPs) are crucial for optimizing antibiotic use in healthcare settings.
- Latin America faces unique challenges in implementing and evaluating ASPs in intensive care units (ICUs).
Purpose of the Study:
- To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical-surgical intensive care units (MS-ICUs) across Latin America.
- To evaluate the effectiveness of ASPs in improving antimicrobial utilization and patient outcomes.
- To identify factors associated with successful ASP implementation in resource-limited settings.
Main Methods:
- A quasi-experimental prospective study with a continuous time series design was conducted over 12 months.
- Seventy-seven MS-ICUs in 9 Latin American countries participated, including adult patients admitted for at least 24 hours.
- Antimicrobial stewardship program (ASP) impact was evaluated monthly using antimicrobial consumption, treatment appropriateness, mortality, and multidrug-resistant organism healthcare-associated infections (MDRO-HAIs), alongside self-assessment surveys.
Main Results:
- MS-ICUs with higher ASP quality scores demonstrated significantly better performance across key indicators.
- Compared to MS-ICUs in the lowest quartile, those in the highest quartile showed reduced antimicrobial consumption (143.4 vs 159.4 DDD/100 patient-days) and MDRO-HAIs (9.45 vs 10.96 per 1000 patient-days).
- Improved adherence to clinical guidelines (92.5% vs 59.3%) and pharmacist prescription validation (72.0% vs 58.0%) were observed in high-performing ASPs, alongside lower crude mortality (15.9% vs 17.7%).
Conclusions:
- Comprehensive antimicrobial stewardship programs (ASPs) are associated with significant improvements in antimicrobial utilization in adult medical-surgical intensive care units (MS-ICUs).
- Strengthening ASPs can lead to better antimicrobial prescribing, reduced healthcare-associated infections, and improved patient outcomes in Latin American ICUs.
- The findings underscore the importance of investing in and supporting robust ASPs to combat antimicrobial resistance in critical care settings.
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