Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals

Abstract

Background: There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America.

Methods: We performed an evaluation of ASPs in Latin American HCFs from March 2022 to February 2023 using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability, resources, antibiotic stewardship actions, education, and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point prevalence surveys) and number of multidrug-resistant infections in medical-surgical intensive care units. Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed size, country of HCF, and incidence of infections (when appropriate).

Results: Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed the point prevalence survey, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR, 212.5-285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR], 8.63; 95% CI, 3.03-24.6; P < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41-3.1; P < .001), and less consumption of anti-methicillin-resistant Staphylococcus aureus agents (OR, -8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections.

Conclusions: Higher-level ASP implementation in Latin American HCFs correlated with better compliance with AU guidelines and decreased the use of vancomycin in the intensive care unit, supporting the need to improve resources for ASPs.

Keywords: Latin America; antibiotic use; implementation; resources; stewardship.

Figure 1.

Median scores on the Global Antibiotic Stewardship Evaluation Tool among nonprofit (n = 22) and for-profit (n = 19) health care facilities in Latin American countries, March 2022–February 2023. No statistically significant differences were detected in any of the tool domains. AS, antibiotic stewardship; AU, antibiotic use.

Figure 2.

Antibiotic stewardship actions reported from the Global Antibiotic Stewardship Evaluation Tool by 39 health care facilities in Latin America, March 2022–February 2023. IV, intravenous; OPAT, outpatient parenteral antibiotics; PD, pharmacodynamic; PK, pharmacokinetic; PPRF, postprescription review with feedback; TDM, therapeutic drug monitoring.