Multicenter Evaluation of Antibiotic Use and Antibiotic Stewardship Programs in Latin American Hospitals

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Abstract Background There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America. Methods 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). Results 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; P < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41–3.1; P < .001), and less consumption of anti–methicillin-resistant Staphylococcus aureus agents (OR, −8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections. Conclusions 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.

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