Current Status of Antimicrobial Stewardship Programs in São Paulo Hospitals

Abstract

Background: Antimicrobial stewardship programs (ASPs) consist of coordinated interventions designed to improve and measure appropriate antimicrobial use. Understanding the current structure of ASPs hospitals will support interventions for improvement or implementation of these programs. Objective: We aimed to describe the current status of ASP in hospitals in the state of São Paulo, Brazil. Methods: We conducted a cross-sectional survey regarding ASP of hospitals in São Paulo state, Brazil, from March to July 2018. Through interviews by telephone or e-mail, we asked participants which components of IDSA/SHEA and CDC guidelines had been implemented. Results: The response rate was 30% (28 of 93 hospitals) and 26 of the hospitals (85%) reported having a formal ASP. Policies, practices, and strategies of surveyed ASP are detailed in Table 1. The most frequently implemented strategies were (1) antimicrobial surgical prophylaxis guideline (100%), (2) empiric sepsis guideline (93%), and (3) presence of ASP team member during bedside rounds (96%). The least commonly implemented strategies included prior authorization for all antimicrobials (11%), pharmacokinetic monitoring and adjustment program for patients on IV aminoglycosides (3%). Regarding metrics of the ASP, the most common indicator was the rates of antimicrobial resistance (77%). Overall, 18 hospitals (19%) used defined daily dose and only 29% used days of therapy. Moreover, 61% of hospitals reported their results to hospital the administration and 39% of hospitals reported their results to the prescribers. Conclusions: Most hospitals have a formal ASP, but there are opportunities for improvement. Future efforts should prioritize tracking and reporting ASP metrics.Funding: NoneDisclosures: None