Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Anthropology and Sociology, Universidad del Valle, Guatemala City, Guatemala.
Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S53-S61. doi: 10.1093/cid/ciad184.
Antimicrobial resistance has worsened in Latin America. There is an urgent need to understand the development of antimicrobial stewardship programs (ASPs) and the barriers to implementing effective ASPs in light of limited national action plans or policies to promote ASPs in the region.
We performed a descriptive mixed-methods study of ASPs in 5 Latin American countries in March-July 2022. An electronic questionnaire with an associated scoring system (hospital ASP self-assessment) was used, and ASP development was classified based on the scores (inadequate, 0-25; basic, 26-50; intermediate, 51-75; or advanced, 76-100). Interviews among healthcare workers (HCWs) involved in antimicrobial stewardship (AS) inquired about behavioral and organizational factors that influence AS activities. Interview data were coded into themes. Results from the ASP self-assessment and interviews were integrated to create an explanatory framework.
Twenty hospitals completed the self-assessment, and 46 AS stakeholders from these hospitals were interviewed. ASP development was inadequate/basic in 35% of hospitals, intermediate in 50%, and advanced in 15%. For-profit hospitals had higher scores than not-for-profit hospitals. Interview data validated the self-assessment findings and provided further insight into ASP implementation challenges, which included limited formal hospital leadership support, inadequate staffing and tools to perform AS work more efficiently, limited awareness of AS principles by HCWs, and limited training opportunities.
We identified several barriers to ASP development in Latin America, suggesting the need to create accurate business cases for ASPs to obtain the necessary funding for their effective implementation and sustainability.
拉丁美洲的抗菌药物耐药性问题日益严重。鉴于该地区有限的国家行动计划或政策来促进抗菌药物管理计划（ASPs）的发展，迫切需要了解 ASP 的发展情况以及实施有效 ASP 的障碍。
我们于 2022 年 3 月至 7 月在拉丁美洲的 5 个国家进行了一项关于 ASP 的描述性混合方法研究。我们使用了一份带有相关评分系统（医院 ASP 自我评估）的电子问卷，并根据得分对 ASP 的发展进行了分类（不足，0-25；基础，26-50；中级，51-75；或高级，76-100）。对参与抗菌药物管理（AS）的医疗保健工作者（HCWs）进行的访谈询问了影响 AS 活动的行为和组织因素。访谈数据被编码为主题。从 ASP 自我评估和访谈中获得的结果被整合在一起，创建了一个解释性框架。
有 20 家医院完成了自我评估，来自这些医院的 46 名 AS 利益相关者接受了访谈。35%的医院 ASP 发展不足/基础，50%的医院处于中级水平，15%的医院处于高级水平。营利性医院的得分高于非营利性医院。访谈数据验证了自我评估结果，并进一步深入了解了 ASP 实施面临的挑战，包括医院领导层对 AS 工作的支持有限、人员配备和工具不足，无法更有效地开展 AS 工作、HCWs 对抗菌药物管理原则的认识有限，以及培训机会有限。
我们发现了拉丁美洲 ASP 发展的一些障碍，这表明需要为 ASP 制定准确的商业案例，以获得有效实施和可持续性所需的资金。
