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. 2023 Jul 5;77(Suppl 1):S53-S61.
doi: 10.1093/cid/ciad184.

Deep Dive Into Gaps and Barriers to Implementation of Antimicrobial Stewardship Programs in Hospitals in Latin America

Valeria Fabre  1 , Clara Secaira  2 , Sara E Cosgrove  1 , Fernanda C Lessa  3 , Twisha S Patel  3 , Andrea Alvarado Alvarez  4 , Lucy Marleni Anchiraico  5 , Maria Del Carmen Bangher  6 , Maria Fernanda Barberis  7 , Maria Sol Burokas  8 , Ximena Castañeda  9 , Angel M Colque  10 , Gabriela De Ascencao  11 , Clara Esquivel  12 , Cecilia Ezcurra  13 , Leandro Abel Falleroni  11 , Natalia Frassone  4 , Maria Isabel Garzón  14 , Carlos Gomez  9   15 , José Anel Gonzalez  16 , Daniela Hernandez  14 , Diego Laplume  7 , César Guillermo Lemir  17 , Herberth Maldonado Briones  4 , Mario Melgar  18 , Florencia Mesplet  19 , Guadalupe Martinez  17 , Carlos Morales Pertuz  20 , Cristina Moreno  21 , Corina Nemirovsky  8 , Yanina Nuccetelli  22 , Belén Palacio  23 , Nancy Sandoval  18 , Hernan Vergara  15 , Hugo Videla  22 , Silvina Villamandos  6 , Olmedo Villareal  16 , Alejandra Viteri  19 , Rodolfo Quiros  24
Affiliations

Deep Dive Into Gaps and Barriers to Implementation of Antimicrobial Stewardship Programs in Hospitals in Latin America

Valeria Fabre et al. Clin Infect Dis. .

Abstract

Background: Antimicrobial resistance has worsened in Latin America. There is an urgent need to understand the development of antimicrobial stewardship programs (ASPs) and the barriers to implementing effective ASPs in light of limited national action plans or policies to promote ASPs in the region.

Methods: We performed a descriptive mixed-methods study of ASPs in 5 Latin American countries in March-July 2022. An electronic questionnaire with an associated scoring system (hospital ASP self-assessment) was used, and ASP development was classified based on the scores (inadequate, 0-25; basic, 26-50; intermediate, 51-75; or advanced, 76-100). Interviews among healthcare workers (HCWs) involved in antimicrobial stewardship (AS) inquired about behavioral and organizational factors that influence AS activities. Interview data were coded into themes. Results from the ASP self-assessment and interviews were integrated to create an explanatory framework.

Results: Twenty hospitals completed the self-assessment, and 46 AS stakeholders from these hospitals were interviewed. ASP development was inadequate/basic in 35% of hospitals, intermediate in 50%, and advanced in 15%. For-profit hospitals had higher scores than not-for-profit hospitals. Interview data validated the self-assessment findings and provided further insight into ASP implementation challenges, which included limited formal hospital leadership support, inadequate staffing and tools to perform AS work more efficiently, limited awareness of AS principles by HCWs, and limited training opportunities.

Conclusions: We identified several barriers to ASP development in Latin America, suggesting the need to create accurate business cases for ASPs to obtain the necessary funding for their effective implementation and sustainability.

Keywords: Latin America; antibiotic stewardship.

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Conflict of interest statement

Potential conflicts of interest. V. F. reports funding support from CDC including funding to present this work. S. E. C., reports funding support from the CDC. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Comment in

  • Stewardship in Brazil: A Call for Action.
    Portela de Assis M, Ziembowicz H, Mosmann Menezes R, Santos Gonçalves MR, Machado de Miranda Costa M, Carneiro M. Portela de Assis M, et al. Clin Infect Dis. 2024 Apr 10;78(4):1073-1075. doi: 10.1093/cid/ciad624. Clin Infect Dis. 2024. PMID: 37816149 No abstract available.

References

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