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

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 L...

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Autor principal: Bernan, Marisa Liliana
Formato: Articulo
Lenguaje:Inglés
Publicado: 2024
Materias:
Ciencias Médicas
antibiotic use
antibiotic resistance
Latin America
antimicrobial stewardship
strategies
Acceso en línea:http://sedici.unlp.edu.ar/handle/10915/172962
Aporte de:
SEDICI (UNLP) de Universidad Nacional de La Plata
id I19-R120-10915-172962
record_format dspace
spelling I19-R120-10915-1729622024-11-13T20:11:13Z http://sedici.unlp.edu.ar/handle/10915/172962 Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals Bernan, Marisa Liliana 2024-10-11 2024-11-13T13:46:57Z en Ciencias Médicas antibiotic use antibiotic resistance Latin America antimicrobial stewardship strategies 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. La lista completa de autores puede verse en el archivo asociado. Facultad de Ciencias Médicas Articulo Articulo http://creativecommons.org/licenses/by-nc-nd/4.0/ Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) application/pdf
institution Universidad Nacional de La Plata
institution_str I-19
repository_str R-120
collection SEDICI (UNLP)
language Inglés
topic Ciencias Médicas
antibiotic use
antibiotic resistance
Latin America
antimicrobial stewardship
strategies
spellingShingle Ciencias Médicas
antibiotic use
antibiotic resistance
Latin America
antimicrobial stewardship
strategies
Bernan, Marisa Liliana
Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals
topic_facet Ciencias Médicas
antibiotic use
antibiotic resistance
Latin America
antimicrobial stewardship
strategies
description 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.
format Articulo
Articulo
author Bernan, Marisa Liliana
author_facet Bernan, Marisa Liliana
author_sort Bernan, Marisa Liliana
title Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals
title_short Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals
title_full Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals
title_fullStr Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals
title_full_unstemmed Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals
title_sort antibiotic use in medical–surgical intensive care units and general wards in latin american hospitals
publishDate 2024
url http://sedici.unlp.edu.ar/handle/10915/172962
work_keys_str_mv AT bernanmarisaliliana antibioticuseinmedicalsurgicalintensivecareunitsandgeneralwardsinlatinamericanhospitals
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