Sustainability Failure in the Antimicrobial Stewardship Program in a Secondary Care Hospital from Cuba: A Historical Review of 30 Years and 3 Shots

Abstract

Background: During the last 30 years, an Antimicrobial Stewardship Program (ASP) was implemented in a facility with periods of weakness. We aim to describe the history of sustainability failure in the local ASP. Methods: A historical review was conducted using original data from the facility library and papers published. An analysis of factors related to the failure was conducted based on the Doyle approach. Results: The first ASP was implemented from 1989 to 1996 based on the international experiences and contributed to the improvement in the quality of prescription, reduction of 52% in cost and in the incidence of nosocomial infection. The second program restarted in 2008 and declined in 2015, while, the third program was guided by the Pan-American Health Organization from 2019. This program, in progress, is more comprehensive than previous ones and introduced as a novel measure the monitoring of antibiotic prophylaxis in surgery. The factors related to the sustainability were considered including the availability of antimicrobials, the leader´s support, safety culture, and infrastructure. Conclusions: The history behind thirty years of experiences in antimicrobial stewardship programs has allowed us to identify the gaps that require proactive strategies and actions to achieve sustainability and continuous quality improvement.