Clínica Ángel Foianini, Santa Cruz de la Sierra, Bolivia.
Henry Ford Health System, Detroit, Michigan, United States.
Infect Control Hosp Epidemiol. 2022 Feb;43(2):181-190. doi: 10.1017/ice.2021.80. Epub 2021 Apr 8.
To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical-surgical intensive care units (MS-ICUs) in Latin America.
Quasi-experimental prospective with continuous time series.
The study included 77 MS-ICUs in 9 Latin American countries.
Adult patients admitted to an MS-ICU for at least 24 hours were included in the study.
This multicenter study was conducted over 12 months. To evaluate the ASPs, representatives from all MS-ICUs performed a self-assessment survey (0-100 scale) at the beginning and end of the study. The impact of each ASP was evaluated monthly using the following measures: antimicrobial consumption, appropriateness of antimicrobial treatments, crude mortality, and multidrug-resistant microorganisms in healthcare-associated infections (MDRO-HAIs). Using final stewardship program quality self-assessment scores, MS-ICUs were stratified and compared among 3 groups: ≤25th percentile, >25th to <75th percentile, and ≥75th percentile.
In total, 77 MS-ICU from 9 Latin American countries completed the study. Twenty MS-ICUs reached at least the 75th percentile at the end of the study in comparison with the same number who remain within the 25th percentile (score, 76.1 ± 7.5 vs 28.0 ± 7.3; P < .0001). Several indicators performed better in the MS-ICUs in the 75th versus 25th percentiles: antimicrobial consumption (143.4 vs 159.4 DDD per 100 patient days; P < .0001), adherence to clinical guidelines (92.5% vs 59.3%; P < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; P < .0001), crude mortality (15.9% vs 17.7%; P < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; P = .004).
MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.
评估拉丁美洲成人内科重症监护病房（MS-ICU）中抗菌药物管理计划（ASPs）的影响。
准实验前瞻性连续时间序列。
研究纳入了 9 个拉丁美洲国家的 77 个 MS-ICU。
至少入住 MS-ICU 24 小时的成年患者纳入本研究。
这一多中心研究进行了 12 个月。为了评估 ASPs，所有 MS-ICU 的代表在研究开始和结束时进行了自我评估调查（0-100 分制）。每月使用以下措施评估每个 ASP 的影响：抗菌药物使用量、抗菌药物治疗的适当性、粗死亡率和医疗保健相关感染（MDRO-HAI）中的多药耐药微生物。使用最终管理计划质量自我评估评分，将 MS-ICU 分层并在 3 组之间进行比较：≤第 25 百分位数、>第 25 至<第 75 百分位数和≥第 75 百分位数。
共有来自 9 个拉丁美洲国家的 77 个 MS-ICU 完成了研究。与仍处于第 25 百分位数的 20 个 MS-ICU 相比，在研究结束时至少达到第 75 百分位数的 MS-ICU 数量有所增加（评分分别为 76.1±7.5 与 28.0±7.3；P<0.0001）。在第 75 百分位数与第 25 百分位数相比，MS-ICU 的多个指标表现更好：抗菌药物使用量（143.4 与 159.4 DDD/100 患者日；P<0.0001）、临床指南遵循率（92.5%与 59.3%；P<0.0001）、药剂师处方验证率（72.0%与 58.0%；P<0.0001）、粗死亡率（15.9%与 17.7%；P<0.0001）和 MDRO-HAI（9.45 与 10.96 例/1000 患者日；P=0.004）。
抗菌药物管理计划更全面的 MS-ICU 显示抗菌药物使用显著改善。
