Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes.
Infect Control Hosp Epidemiol
; 43(2): 181-190, 2022 02.
Article
em En
| MEDLINE
| ID: mdl-33829982
ABSTRACT
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 followingmeasures:
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Gestão de Antimicrobianos
Tipo de estudo:
Clinical_trials
/
Guideline
/
Observational_studies
/
Qualitative_research
/
Risk_factors_studies
/
Sysrev_observational_studies
Aspecto:
Implementation_research
Limite:
Adult
/
Humans
Idioma:
En
Revista:
Infect Control Hosp Epidemiol
Ano de publicação:
2022
Tipo de documento:
Article