Fabre Valeria, Cosgrove Sara E, Hsu Yea-Jen, Patel Twisha S, Lessa Fernanda C, Alvarado Andrea, Aquiles Bowen, Arauz Ana B, Barberis Maria F, Bangher Maria Del Carmen, Bernachea Maria P, Bernan Marisa L, Canton Alfredo, Castañeda Ximena, Colque Angel M, Contreras Rosa, Cornistein Wanda, Correa Silvia Mabel, Costilla Campero Gustavo, Chamorro Ayala Marta Isabel, Espinola Lidia, Esquivel Clara, Ezcurra Cecilia, Fernandez Johana, Ferrari Sandra, Frassone Natalia, Garcia Cruz Carlos, Garzón Maria Isabel, Gomez Quintero Carlos H, Gonzalez José A, Guaymas Lucrecia, Guerrero-Toapanta Fausto, Lambert Sandra, Laplume Diego, Lopez Itzel L, Maldonado Herberth, Mañez Noelia, Maurizi Diego M, Melgar Mario, Mesplet Florencia, Morales Pertuz Carlos, Moreno Izquierdo Cristina, Moya Luciana Gabriela, Nuccetelli Yanina, Núñez Glendys, Olmedo Argelis, Palacio Belén, Pauluzzi Antonella, de Paz Sierra Mariana, Pellice Florencia, Perez Alvear Loraine, Raffo Carla Lorena, Reino Fanny, Vence Reyes Ligia, Ricoy Gerardo, Rodriguez Viviana E, Romero Federico, Romero Juan J, Ruiz Mariquena, Russo Maria Eugenia, Sadino Graciela, Sandoval Nancy, Staffolani Natalia, Torralvo Maria Jose, Urueña Alejandra M, Videla Hugo, Valle Marisol, Vera Amate Perez Silvia, Vergara-Samur Hernan, Villamandos Silvina, Villarreal Olmedo, Warley Eduardo, Reyes-Morales Guadalupe, Quiros Rodolfo E
Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg of School of Public Health, Baltimore, Maryland, USA.
Open Forum Infect Dis. 2025 Jun 25;12(7):ofaf364. doi: 10.1093/ofid/ofaf364. eCollection 2025 Jul.
There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America.
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).
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; < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41-3.1; < .001), and less consumption of anti-methicillin-resistant agents (OR, -8.59; SE = 4.12; = .037) after adjusting for bed size, country, and incidence of methicillin-resistant infections.
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.
拉丁美洲医疗机构（HCFs）抗菌药物管理计划（ASP）的实施程度相关知识有限。
我们在2022年3月至2023年2月期间，使用与评分系统相关的结构化自我评估调查对拉丁美洲HCFs的ASP进行了评估，该评分系统评估了领导支持与问责、资源、抗菌药物管理行动、教育以及抗菌药物使用（AU）监测与报告。此外，我们收集了医疗外科重症监护病房每月的AU数据（抗菌药物消费和现患率调查）以及多重耐药感染的数量。通过多变量回归模型，在调整床位规模、HCF所在国家以及感染发生率（如适用）后，将自我评估分数与AU进行关联。
在为该研究招募的39个HCFs中，所有机构均完成了自我评估，36个机构进行了现患率调查，29个机构收集了抗菌药物消费数据。总体自我评估中位数得分为252.5（四分位间距，212.5 - 285），最高可能得分为335。在调整床位规模、国家以及耐甲氧西林感染发生率后，较高的自我评估分数（上四分位数）与更高的符合指南的AU相关（优势比[OR]，8.63；95%置信区间，3.03 - 24.6；P <.001），更高的针对性治疗使用率（OR，2.11；95%置信区间，1.41 - 3.1；P <.001），以及更少的耐甲氧西林抗菌药物消费量（OR， - 8.59；标准误 = 4.12；P =.037）。
拉丁美洲HCFs中更高水平的ASP实施与更好地遵守AU指南相关，并减少了重症监护病房中万古霉素的使用，支持了改善ASP资源的必要性。
