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

Background The 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. Methods A 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. Results 333 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). Conclusion The 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.

Yoğun Bakım Hastalarında Antimikrobiyal İlaç Dozajlarının Uygunluğunun Değerlendirilmesi

“…In the literature, the effect of pharmacist collaboration in antimicrobial therapy management was investigated. In an observational study conducted In another observational study, the impact of pharmacist-driven antimicrobial stewardship on the prescription of antibiotics in an ICU was investigated [13].…”

Assessing Antimicrobial Consumption in Public and Private Sectors within the Costa Rican Health System: Current Status and Future Directions

“…Therefore, in the private hospital setting, it is estimated that the use of antibiotics with a high epidemiological impact, such as Ceftriaxone, Ertapenem, Levo oxacin, Vancomycin, and Meropenem, is particularly notable. The high use of Carbapenems is an important aspect to consider, since there are reports of private hospitals with low prevalence of ESBLs [30].…”

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].…”