Antibiotic Use in Medical-Surgical Intensive Care Units and General Wards in Latin American Hospitals
Abstract Objectives 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, b...
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Published in | Open forum infectious diseases |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
11.10.2024
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Online Access | Get full text |
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Summary: | Abstract Objectives 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-February 2023. Patients >18 years of age on 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 5,780 MS-ICU and 7,726 Gral-ward patients. Hospitals’ median bed-size was 179 (IQR 125, 330), 52% were non-profit. 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. Healthcare-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 underwent therapeutic drug monitoring. In both units, 17% of antibiotics prescribed as targeted therapy represented de-escalation, while 24% and 15% in MS-ICU and Gral-ward, 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 for > 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. |
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ISSN: | 2328-8957 2328-8957 |
DOI: | 10.1093/ofid/ofae620 |