Implementation of Antimicrobial Stewardship Programs in Adult Intensive Care Units and General Wards at Argentinean Hospitals: The PROA Project

Quirós, Rodolfo; Cabral, Myrna; Bertuzzi, Romina; Caeiro, Juan Pablo; Rodríguez, Viviana; Pfoh, Maria; Vila, Adrea; Maurizi, Diego; Calanni, Liliana; Vitolo, Valeria; Capello, Sandra; Carbone, Edith; Bangher, María del Carmen; Escobar, Elvio D

doi:10.1016/j.ijid.2018.04.3737

Cited by 3 publications

(7 citation statements)

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“…15 The feasibility of doing a prevalence survey has been demonstrated in previous studies. 25,27 This methodology has allowed hospitals in LMICs to assess antibiotic prescribing patterns and to collect information about antibiotic resistance for the first time. In that sense, measurement of appropriateness of antimicrobial prescription is essential for monitoring and reporting ASPs.…”

Section: Discussionmentioning

confidence: 99%

“…The study was built using methodology from a prior study. 25 The study was conducted over a 24-month period with a 6-month preintervention period, a 12-month intervention period, and a 6month postintervention study period.…”

Section: Methodsmentioning

confidence: 99%

“…During this period, each center completed a baseline self-assessment of their ASP through a previously validated instrument (Supplementary Material 1 online). 25 During the 12-month intervention period and based on the results of the baseline self-assessment, each center implemented locally salient antimicrobial stewardship strategies in MS-ICUs as part of the ASP. During this period, monthly surveys were performed to measure the appropriateness of antimicrobial prescription, antimicrobial consumption, mortality, and incidence of MDRO-HAIs.…”

Section: Methodsmentioning

confidence: 99%

“…A standardized surveillance methodology was used to collect data from antimicrobial prescriptions. 25,27 Monthly 1-day prevalence surveys, including all inpatients who were in an MS-ICU at 8:00 A.M. and who received at least 1 systemic antimicrobial, were collected. Survey information included characteristics of the patient (ie, age, gender, weight) and the antimicrobial prescription (ie, therapeutic indication, unit dose, number of daily doses, administration route, pharmacist validation, dose adjustments, and therapeutic drug monitoring).…”

Section: Data Collectionmentioning

confidence: 99%

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Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes

Quirós

Bardossy

Angeleri³

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical–surgical intensive care units (MS-ICUs) in Latin America. Design: Quasi-experimental prospective with continuous time series. Setting: The study included 77 MS-ICUs in 9 Latin American countries. Patients: Adult patients admitted to an MS-ICU for at least 24 hours were included in the study. Methods: This multicenter study was conducted over 12 months. To evaluate the ASPs, representatives from all MS-ICUs performed a self-assessment survey (0–100 scale) at the beginning and end of the study. The impact of each ASP was evaluated monthly using the following measures: antimicrobial consumption, appropriateness of antimicrobial treatments, crude mortality, and multidrug-resistant microorganisms in healthcare-associated infections (MDRO-HAIs). Using final stewardship program quality self-assessment scores, MS-ICUs were stratified and compared among 3 groups: ≤25th percentile, >25th to <75th percentile, and ≥75th percentile. Results: In total, 77 MS-ICU from 9 Latin American countries completed the study. Twenty MS-ICUs reached at least the 75th percentile at the end of the study in comparison with the same number who remain within the 25th percentile (score, 76.1 ± 7.5 vs 28.0 ± 7.3; P < .0001). Several indicators performed better in the MS-ICUs in the 75th versus 25th percentiles: antimicrobial consumption (143.4 vs 159.4 DDD per 100 patient days; P < .0001), adherence to clinical guidelines (92.5% vs 59.3%; P < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; P < .0001), crude mortality (15.9% vs 17.7%; P < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; P = .004). Conclusion: MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

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Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes

Quirós

Bardossy

Angeleri³

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…The increasing number of publications on the topic suggests a growing interest and commitment to tackling AMR in LAC. ASP efforts are not as ubiquitous as they are in the United States, France, or the United Kingdom ( 7 ), but increasingly LAC countries report the involvement of widely-distributed hospital networks ( 20 , 21 ). Considering that only 18 countries have published their experience with antimicrobial stewardship initiatives, it is necessary to keep working towards extending and strengthening these efforts in the region.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review

Hegewisch-Taylor

Dreser

Romero-Mónico

et al. 2020

Revista Panamericana De Salud Pública

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Objectives. To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting. Methods. This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included ‘antibiotic’ or ‘antimicrobial’ AND ‘stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions’ and 33 country names. Results. Selected articles totalled 147 studies published in 1985 – 2019; of those, 22% used ‘antimicrobial stewardship’ in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements. Conclusions. Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.

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Antimicrobial stewardship in Latin America: Past, present, and future

Fabre

Cosgrove

Secaira

et al. 2022

ASHE

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Implementation of antimicrobial stewardship programs (ASPs) in well-resourced countries has been associated with reductions in antibiotic-resistant infections and improved patient outcomes. Several guidance documents providing recommendations on how to structure antimicrobial stewardship activities at the national and hospital level in resource-limited settings have been published. However, few hospitals in Latin America report having a structure or resources needed for a successful ASP. Given the alarming increases in antimicrobial resistance in Latin America, better understanding of barriers to promote implementation of effective ASPs is urgently needed. We have summarized past and present antimicrobial stewardship activities in Latin American hospitals, and we describe key elements needed in future efforts to strengthen antimicrobial stewardship in the region.

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Implementation of Antimicrobial Stewardship Programs in Adult Intensive Care Units and General Wards at Argentinean Hospitals: The PROA Project

Cited by 3 publications

References 0 publications

Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes

Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes

Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review

Antimicrobial stewardship in Latin America: Past, present, and future

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