Impact of Antimicrobial Stewardship Programs in Latin American Adult Intensive Care Units: PROA-LATAM Project

• Published in: Infection control and hospital epidemiology 2020-10, Vol.41 (S1), p.s520-s520
• Main Authors: Quirós, Rodolfo, Angeleri, Patricia, Zurita, Jeannete, Aleman, Washington, Carneiro, Marcelo, Guerra, Silvia, Medina, Julio, Luquerna, Ximena Castañda, Guerra, Alexander, Vega, Silvio, Cuéllar, Luis, Munita, Jose, Maki, Gina, Prentiss, Tyler, Escobar, Elvio, Foianini, Ángel, Zervos, Marcus, Bardossy, Ana
• Format: Article
• Language: English
• Subjects: Antimicrobial agents; Disease control; Drug resistance; Hospitals; Intensive care; Microorganisms; Prophylaxis; Self evaluation
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2020.1203

Background: Antimicrobial stewardship programs (ASPs) are useful in improving clinical outcomes in a cost-effective way and in reducing antimicrobial resistance. Objective: We sought to determine the impact of ASP in adult medical-surgical intensive care units (MS-ICUs). Methods: A multicenter study, in 77 MS-ICUs of 9 Latin-American countries, was conducted along 12 months (July 2018–June 2019). A self-assessment survey using a tool based on CDC recommendations (0–100 scale) was performed at the beginning, after 6 months, and at the end of the study. The impact of ASP was evaluated monthly using the following indicators: antimicrobial consumption (defined daily doses [DDD] per 100 patient days), appropriateness of antimicrobial prescriptions (percentage of total prescriptions), crude mortality rate (events per 100 discharges), and hospital-acquired multidrug-resistant microorganisms (MDRs) and Clostridioides difficile infections (CDI events per 1,000 patient days). These indicators were compared between MS-ICUs that reached the 75th percentile and those that maintained the 25th percentile at the final self-assessment. Results: Of all indicators evaluated, only surgical prophylaxis ≤24 hours, vancomycin therapeutic monitoring, and aminoglycosides (1 dose per day) did not show significant differences between MS-ICUs at the 75th percentile and the 25th percentile. CDI events were significantly higher at the 75th percentile MS-ICUs, probably related to better detection of C. difficile (Table 1). Conclusions: This study confirmed that MS-ICUs with more comprehensive ASPs had significantly better indicators. Funding: Proprietary Organization: MERCK Disclosures: None