1780. Results of a Successful Implementation of a Antimicrobial Stewardship Program in a Public Hospital in São Paulo, Brazil

Abstract

BackgroundThe implementation of antimicrobial stewardship program is one of the basis for the control of multidrug-resistant bacteria (MDR) and the reduction of unnecessary costs, especially in public hospitals. The use of a multimodal strategy is fundamental to the success of a stewardship program.MethodsThis is an analysis of antimicrobial consumption in intensive care unit (ICU) of a public hospital in São Paulo, Brazil, before and after the implementation of the antibiotic stewardship program. In the pre-intervention period—January 2014 to December 2015—the rational use of antimicrobials was based only on postprescription authorization by the infectious diseases doctor. Since January 2016 was established an antibiotic stewardship program based on authorization of antimicrobial use, implementation of an empirical antibiotic protocol according to institutional microbiological profile, measurement of adherence to the protocol and feedback to the leadership, pharmaceutical intervention, educational measures for medical staff and leadership engagement to the program. We compared consumption in DDD per 1,000 patient-days (1,000/pd) and mean cost with antimicrobials in the ICU in US dollars.ResultsThe overall antimicrobial consumption reduced from 1,032 DDD/1,000 pd in the preintervention period to 785 DDD/1,000 pd postintervention. Analysis stratified by individual antibiotic was done for the five most commonly used antibiotics. A reduction of 51% consumption for meropenem, 41% for colistin, and 41% for vancomycin was observed. Antibiotic costs were reduced from a monthly median of US$71,176.49 to US$43,772.75 between the two periods. No difference in mortality or mean Apache was observed over the period.ConclusionThe implementation of the antimicrobial stewardship program can lead to a safe reduction in antibiotic use in the ICU, with significant reduction of costs that can be reapplied in the patient care. Further analyzes are needed to assess the impact on clinical patient outcomes.Disclosures All authors: No reported disclosures.