Impact of antimicrobial stewardship programs on antibiotic consumption and antimicrobial resistance in four Colombian healthcare institutions

Abstract

Background Antimicrobial stewardship programs (ASPs) have become a fundamental pillar in optimizing antimicrobial usage, improving patient care, and reducing antimicrobial resistance (AMR). Herein we evaluated the impact of an ASP on antimicrobial consumption and AMR in Colombia. Methods We designed a retrospective observational study and measured trends in antibiotic consumption and AMR before and after the implementation of an ASP using interrupted time series analysis over a 4-year period (24 months before and 24 months after ASP implementation). Results ASPs were implemented according to the available resources in each of the institutions. Before ASP implementation, there was a trend toward an increase in the antibiotic consumption of all measured antimicrobials selected. Afterward, an overall decrease in antibiotic consumption was observed. The use of ertapenem and meropenem decreased in hospital wards, while a decrease in the use of ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, and vancomycin was observed in intensive care units. After ASP implementation, the trend toward an increase of oxacillin-resistant Staphylococcus aureus, ceftriaxone-resistant Escherichia coli, and meropenem-resistant Pseudomonas aeruginosa was reversed. Conclusions In our study, we showed that ASPs are a key strategy in tackling the emerging threat of AMR and have a positive impact on antibiotic consumption and resistance.

Drug and therapeutics committee interventions in managing irrational drug use and antimicrobial stewardship in China

“…The DTC organized Committee members and clinical medicine and clinical pharmacy experts to conduct dynamic monitoring of prescribed medications, regularly sampling prescriptions or cases for reasonable evaluation. The evaluation results have been reported ( Yang et al, 2021 ; Pallares et al, 2022 ). The types of irrational drug use, DTC interventions, and outcomes of the intervention were recorded by clinical pharmacists.…”

Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review

“…ASPs brought about positive clinical outcomes in hospital inpatients in most cases. Microbiological outcomes to assess the impact of ASP were reported in 42% (22/53) of studies [ 63 , 65 , 66 , 71 , 76 , 79 , 81 – 85 , 87 – 89 , 100 , 101 , 109 , 110 ], including a decrease in the prevalence of multi-drug resistance bacterial strains like Acinetobacter spp , Methicillin-Resistant Staphylococcus aureus (MRSA) , Vancomycin-Resistant Enterococcus [VRE], increase in the antibiotic susceptibility of bacterial strains such as Pseudomonas aeruginosa, E. coli [ 71 , 81 , 82 , 85 ]. Studies also documented a reduction in the incidence of bacterial infections such as Clostridioides difficile infections and Candidemia [ 75 , 77 ], and a decrease in pan-drug resistant isolates [ 65 , 71 , 77 , 85 ].…”

“…Our review found that ASP interventions achieved improvement in rational antibiotic prescription through dose optimization, antibiotic de-escalation, and a reduction in antibiotic prescriptions. ASP implementation documented a reduction in the consumption of WATCH category antibiotics such as vancomycin, meropenem, aztreonam, ceftriaxone, and RESERVE category antimicrobials like colistin, carbapenems, teicoplanin, in hospital wards and ICUs [ 46 , 63 , 71 , 77 , 82 , 83 , 100 – 102 ]. Prior systematic reviews demonstrated a decrease in antibiotic consumption after ASP implementation in the ICUs of hospitals [ 2 , 24 ].…”

“…Prior systematic reviews also confirmed that stewardship activities resulted in positive clinical outcomes [ 19 , 113 ]. These findings imply that ASPs curb needless antibiotic consumption among hospital inpatients, and show a positive impact on microbiological outcomes, such as a reduction in the prevalence of multi-drug resistance [ 82 , 83 , 88 ] and bacterial resistance [ 82 , 83 ]. Though fewer studies reported ASPs’ impact on economic outcomes, the studies in this review showed a positive effect on ASP implementation which was reiterated by prior reviews that revealed the beneficial effects of ASPs in terms of cost reduction in clinical settings [ 15 , 114 ].…”

Compliance with antibiotic therapy guidelines in French pediatric intensive care units (COMITY study)

“…In all these situations, intensivists should be more attentive to guidelines. By reducing inappropriate prescriptions, antibiotic consumption and drug resistance [43,44], the ASP has provided strong evidence of e cacy, but they are time-consuming and require dedicated funding. We suggest a daily ASP in these error-prone situations, to improve compliance with guidelines.…”