Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica

Abstract

Objective. To measure the impact generated by the implementation of the pharmacy-driven antimicrobial stewardship program of the Clínica Bíblica Hospital. Methods. This is a retrospective observational study that evaluates the consumption of antibiotics for the periods before and during implementation of the Clínica Bíblica Hospital antimicrobial stewardship program, calculated by means of defined daily dose per 1 000 patient-days and days of therapy per 1 000 patient-days. In addition, bacterial resistance patterns for the periods 2014–2015 and 2016–2017 were compared. Results. Consumption of most-used antibiotics was calculated, looking for trends that might be associated with the activities implemented by the Clínica Bíblica Hospital antimicrobial stewardship program. Comparing some of the antibiotics with the highest consumption in periods I and II, use of levofloxacin and ceftriaxone showed a decrease of 54.0% (p < 0.001) and 14.6% (p = 0.003), respectively, whereas there was an increase in the use of cefazolin of 4 539.3% (p < 0.001). Regarding percentage of bacterial resistance, in most bacterial isolates no statistically significant changes were observed between the two periods. Conclusions. A reduction in the overall consumption of antibiotics has been achieved over time, most likely attributable to the antimicrobial stewardship program. However, this trend was not observed for all the antibiotics studied. The pattern of resistance among the commonly isolated microorganisms did not vary greatly between the periods studied, which suggests that either the antimicrobial stewardship program may have prevented an increase in bacterial resistance since its implementation, or that it is too soon to see impact on bacterial resistance.

Insights into clinical pharmacy practice in Latin America

“…28,46 There are only two universities in Costa Rica that provide a spe- Program (AMS) in national hospitals, such as Hospital México, and some private hospitals, such as Hospital Clínica Bíblica. 48 Despite the challenges that the country faces, there is a coordinated effort to adapt clinical pharmacy practices that have already been established in other countries, such as the participation of a pharmacist in a multidisciplinary CPR team, deprescription in a polymedicated patient, and opioid stewardship.…”

“…However, it has been shown that, within the next generations of professionals and pharmacists, exists significant interest to engage with this area. An example of the progress made in the field is the implementation of an Antimicrobial Stewardship Program (AMS) in national hospitals, such as Hospital México, and some private hospitals, such as Hospital Clínica Bíblica 48 …”

Antibiotic Consumption in Primary Care in Costa Rica and Italy: A Retrospective Cross-Country Analysis

“…In Costa Rica, these programs have been shown to improve the consumption of antibiotics such as firstgeneration cephalosporins, third-generation cephalosporins, and fluoroquinolones, as well as changes in the prescription habits of medical specialists in surgery and intensive care [24][25][26]. On the other hand, in Italy the implementation of these programs has improved patient clinical outcomes in terms of readmission, mortality rate, improvements in therapy selection, and cost reduction [27].…”

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

“…As greater confidence was generated among health professionals and the AMS developed within the hospital, several other improvement opportunities were detected related to the prescribing of antimicrobials, mainly related to surgical antibiotic prophylaxis and the wide use of broad-spectrum antibiotics. 15 It has been described in current literature that one of the main areas to optimize the use of antimicrobials in the ICU. 16 Moreover, interventions performed by a clinical pharmacist have been reported…”

“…The first steps of the AMS consisted of not setting‐up restrictions for antibiotics but as a joint group for establishing antimicrobial policies and providing education to all clinicians about the importance of preventing bacterial resistance. As greater confidence was generated among health professionals and the AMS developed within the hospital, several other improvement opportunities were detected related to the prescribing of antimicrobials, mainly related to surgical antibiotic prophylaxis and the wide use of broad‐spectrum antibiotics 15 …”