Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Health Services Research

Background:

• Limited evidence exists on antimicrobial stewardship programmes in less-resourced settings.
• Antimicrobial overuse and narrow-spectrum agent use are key concerns in intensive care units (ICUs).
• This study addresses the need for improved antibacterial prescription quality in middle-income countries.

Purpose of the Study:

• To implement and evaluate an antimicrobial stewardship program in ICUs within a middle-income country.
• To mitigate overuse and promote narrow-spectrum antibacterial agents.
• To improve the quality of antibacterial prescriptions.

Main Methods:

• A quality improvement collaborative (QIC) model was established involving nine Argentine ICUs over 11 months.
• The intervention included audits, feedback, facility-specific guidelines, timeouts, pharmacy interventions, and education.
• Data were collected during a 16-week baseline period (BP) and a 32-week implementation period (IP).

Main Results:

• A total of 912 patients were included (357 in BP, 555 in IP), with higher severity scores in the IP.
• Antibacterial de-escalation based on microbiological culture significantly increased during the IP (62.0% vs 45.3%, p<0.001).
• Days of antibacterial therapy (DOT) and defined daily doses (DDD) showed no significant difference between BP and IP.

Conclusions:

• Implementing an antimicrobial stewardship program via a QIC successfully improved antibacterial de-escalation in ICUs.
• The program did not significantly alter DOT or DDD, indicating a need for further refinement.
• Eight out of nine ICUs demonstrated improvement in their Infection Prevention and Control (IPC) Assessment Framework Score.