Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals
Valeria Fabre, Sara E Cosgrove, Yea-Jen Hsu, Twisha S Patel, Fernanda C Lessa, Andrea Alvarado, Bowen Aquiles, Ana B Arauz, Maria F Barberis, Maria Del Carmen Bangher, Maria P Bernachea, Marisa L Bernan, Alfredo Canton, Ximena Castañeda, Angel M Colque, Rosa Contreras, Wanda Cornistein, Silvia Mabel Correa, Gustavo Costilla Campero, Marta Isabel Chamorro Ayala, Lidia Espinola, Clara Esquivel, Cecilia Ezcurra, Johana Fernandez, Sandra Ferrari, Natalia Frassone, Carlos Garcia Cruz, Maria Isabel Garzón, Carlos H Gomez Quintero, José A Gonzalez, Lucrecia Guaymas, Fausto Guerrero-Toapanta, Sandra Lambert, Diego Laplume, Itzel L Lopez, Herberth Maldonado, Noelia Mañez, Diego M Maurizi, Mario Melgar, Florencia Mesplet, Carlos Morales Pertuz, Cristina Moreno Izquierdo, Luciana Gabriela Moya, Yanina Nuccetelli, Glendys Núñez, Argelis Olmedo, Belén Palacio, Antonella Pauluzzi, Mariana de Paz Sierra, Florencia Pellice, Loraine Perez Alvear, Carla Lorena Raffo, Fanny Reino, Ligia Vence Reyes, Gerardo Ricoy, Viviana E Rodriguez, Federico Romero, Juan J Romero, Mariquena Ruiz, Maria Eugenia Russo, Graciela Sadino, Nancy Sandoval, Natalia Staffolani, Maria Jose Torralvo, Alejandra M Urueña, Hugo Videla, Marisol Valle, Silvia Vera Amate Perez, Hernan Vergara-Samur, Silvina Villamandos, Olmedo Villarreal, Eduardo Warley, Guadalupe Reyes-Morales, Rodolfo E QuirosAbstract
Background
There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in healthcare facilities (HCF) in Latin America.
Methods
We performed an evaluation of ASPs in Latin-American HCFs, March 2022-February 2023, using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability; resources; antibiotic stewardship (AS) actions; education; and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point-prevalence surveys [PPS]), and number of multi-drug-resistant infections in medical-surgical intensive care units (ICUs). Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed-size, country of HCF, and incidence of infections (when appropriate).
Results
Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed PPS, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR 212.5, 285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR] 8.63, confidence interval [CI] 3.03 - 24.6, P<0.001), higher use of directed therapy (OR 2.11, CI 1.41 - 3.1, P<0.001), and less consumption of anti-MRSA agents (OR -8.59, SE 4.12, P=0.037) after adjusting for bed-size, country, and incidence of MRSA infections.
Conclusions
Higher level of ASP implementation in Latin-American HCFs correlated with better compliance with AU guidelines and decreased use of vancomycin in the ICU supporting the need to improve resources for ASPs.