Impact of a pharmacist‐driven antimicrobial stewardship program on the prescription of antibiotics by intensive care physicians in a Latin American hospital: A retrospective study

Abstract

AbstractBackgroundThe implementation of antimicrobial stewardship programs (AMS) has shown to be an effective tool for the rational use of antimicrobials, but this has been challenging in several Latin American countries, due to limited resources, such as the lack of trained clinical pharmacists in infectious disease. This study aims to determine the impact of a pharmacist‐driven AMS on the prescription of antibiotics by intensive care physicians (ICPs) and the bacterial resistance patterns in a Latin American hospital.MethodsA retrospective observational study was conducted that compared the optimal selection and the consumption (days of therapy/1000 ICP patient‐days) of antibiotics in patients treated by intensive care unit (ICU) physicians, before and after AMS implementation, defined as pre‐AMS (January–December 2014) and post‐AMS (January 2020–March 2021) at Hospital Clínica Bíblica, Costa Rica. Bacterial resistance patterns were also compared.Results333 patients met the inclusion criteria (52% pre‐AMS and 48% post‐AMS). After a five‐year intervention, the optimal antibiotic selection prescribed by ICP was 43.1% (n = 75) in the pre‐AMS period and 86.8% (n = 138) in the post‐AMS period (43.7% absolute improvement, P < 0.001). The prescription trends of some antibiotics showed an improvement, such as ertapenem in 45% (P < 0.001) and levofloxacin in 59% (P < 0.001). Also, there was an improvement in some empiric antibiotic prescriptions with the diagnosis, including an increase of 32% (P < 0.001) in Community‐Acquired Pneumonia. There was a reduction in the consumption of antimicrobials including a decrease of 66.9% (P = 0.017) for vancomycin and 64.7% (P = 0.033) for meropenem. Regarding bacterial resistance, the study found a decrease of 11% (P = 0.048) in Pseudomonas aeruginosa resistant to meropenem and a reduction in the detection of extended‐spectrum beta‐lactamase in Escherichia coli (11% decrease; P = 0.007).ConclusionThe pharmacist‐driven AMS showed a positive impact on antibiotic selection and consumption in ICU patients. In addition, strategies implemented through the AMS could have had a beneficial impact on antibiotic resistance.