Antibiotic Use in Medical-Surgical Intensive Care Units and General Wards in Latin American Hospitals

Abstract

Background: The objective of this study was to identify antibiotic stewardship (AS) opportunities in Latin American medical-surgical intensive care units (MS-ICUs) and general wards (Gral-wards).

Methods: We conducted serial cross-sectional point prevalence surveys in MS-ICUs and Gral-wards in 41 Latin American hospitals between March 2022 and February 2023. Patients >18 years of age in the units of interest were evaluated for antimicrobial use (AU) monthly (MS-ICUs) or quarterly (Gral-wards). Antimicrobial data were collected using a standardized form by the local AS teams and submitted to the coordinating team for analysis.

Results: We evaluated AU in 5780 MS-ICU and 7726 Gral-ward patients. The hospitals' median bed size (interquartile range) was 179 (125-330), and 52% were nonprofit. The aggregate AU prevalence was 53.5% in MS-ICUs and 25.5% in Gral-wards. Most (88%) antimicrobials were prescribed to treat infections, 7% for surgical prophylaxis and 5% for medical prophylaxis. Health care-associated infections led to 63% of MS-ICU and 38% of Gral-ward AU. Carbapenems, piperacillin-tazobactam, intravenous (IV) vancomycin, and ampicillin-sulbactam represented 50% of all AU to treat infections. A minority of IV vancomycin targeted therapy was associated with documented methicillin-resistant Staphylococcus aureus infection or therapeutic drug monitoring. In both units, 17% of antibiotics prescribed as targeted therapy represented de-escalation, while 24% and 15% in MS-ICUs and Gral-wards, respectively, represented an escalation of therapy. In Gral-wards, 32% of antibiotics were used without a microbiologic culture ordered. Half of surgical prophylaxis antibiotics were prescribed after the first 24 hours.

Conclusions: Based on this cohort, areas to improve AU in Latin American hospitals include antibiotic selection, de-escalation, duration of therapy, and dosing strategies.

Keywords: Latin America; antibiotic resistance; antibiotic use; antimicrobial stewardship; strategies.

Figure 1.

Count of top 5 antibiotic groups used for treatment of infections in MS-ICUs (A) and Gral-wards (B). Penicillins with BLI include ampicillin-sulbactam and amoxicillin-clavulanate. Serial single-day point prevalence surveys were conducted in 41 hospitals from Guatemala, Panama, Ecuador, Colombia, and Argentina during March 2022–February 2022. Abbreviations: BLI, β-lactamase inhibitor; Gral-wards, general wards; IV, intravenous; MS-ICUs, medical–surgical intensive care units.

Figure 2.

Top 3 antibiotics prescribed for treatment of common community-acquired infections including A) community-acquired pneumoina (CAP), B) intra-abdominal infections (IAI), C) skin and soft tissue infections (SSTI), and D) urinary tract infections (UTIs). The denominator is the total number of antibiotics for each indication presented in the figure (ie, CAP treatment antibiotics, n = 551; IAI treatment antibiotics, n = 492; SSTI treatment antibiotics, n = 369; UTI treatment antibiotics, n = 190). Serial single-day point prevalence surveys were conducted in 41 hospitals from Guatemala, Panama, Ecuador, Colombia, and Argentina during March 2022–February 2022.