Abstract
To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical-surgical intensive care units (MS-ICUs) in Latin America. Quasi-experimental prospective with continuous time series. The study included 77 MS-ICUs in 9 Latin American countries. Adult patients admitted to an MS-ICU for at least 24 hours were included in the study. 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. 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). MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.
Highlights
Patients: Adult patients admitted to an medical–surgical intensive care units (MS-ICUs) for at least 24 hours were included in 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
Antimicrobial exposure increases the risk of adverse events, drug interactions, superinfections, and the development of multidrug-resistant organisms (MDROs), fungal infections, Clostridiodes difficile infection (CDI), as well as healthcare costs.[6,7,8,9]
Summary
To evaluate the ASPs, representatives from all MS-ICUs performed a selfassessment 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). The study included a network of hospitals recruited from 9 Latin American countries. A nonrandom sample of 84 MS-ICUs from tertiary-care hospitals in Latin America were invited by infectious disease leaders from each country to voluntarily participate in the project. We included facilities with an ASP team composed of an infectious disease (ID) physician, a clinical pharmacist, and a microbiologist. All study data were deidentified, and patient consent was waived. Ethics approvals varied by country and were obtained by participating hospitals on an individual basis. A data privacy document was made available for each participating hospital
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