Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals

Abstract Background The objective of this study was 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 and February 2023. Patients >18 years of age in 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 5780 MS-ICU and 7726 Gral-ward patients. The hospitals’ median bed size (interquartile range) was 179 (125–330), and 52% were nonprofit. 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. Health care–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 therapeutic drug monitoring. In both units, 17% of antibiotics prescribed as targeted therapy represented de-escalation, while 24% and 15% in MS-ICUs and Gral-wards, 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 after the 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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Publication Details

Journal
Open Forum Infectious Diseases
Published
2024-10-11
DOI
https://doi.org/10.1093/ofid/ofae620
Citations
3
Primary Topic
Antibiotic Use and Resistance
Type
article
Field-Weighted Citation Impact
0.89

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article

Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals

Ana Belén Araúz, Yanina Nuccetelli, Carlos Morales Pertuz, Sandra Lambert et al.
3 citations
Open Forum Infectious Diseases
Antibiotic Use and Resistance
0.89
article

Antibiotic Use in Medical–Surgical Intensive Care Units and General Wards in Latin American Hospitals

Ana Belén Araúz, Yanina Nuccetelli, Carlos Morales Pertuz, Sandra Lambert, Diego Laplume, Natalia Frassone, Angelica Lopez, Fernanda Barberis, Marisa L Bernan, Sara E. Cosgrove, Carla Raffo, Astrid Smud, Vanina Stanek, Hugo Páez, Twisha S Patel, Aquiles Eduardo Bowen Flores, Eduardo Warley, Silvina Villamandos, Mario Melgar, Ángel M Colque, José Anel González, S Sandoval-Fernandez Del Castillo, Viviana Rodríguez, Maria Paula Bernachea, Alejandra Viteri, Gerardo Ricoy, María Isabel Garzón, Washington Alemán, Fernanda C. Lessa, Ximena Castañeda, Cecilia Ezcurra, Valeria Fabre, Florencia Pellice, Wanda Cornistein, Fausto Guerrero-Toapanta, M.J. Torralvo, Florencia Mesplet, Cristina Moreno, Juan José Romero, Virginia Soria, Rodolfo E Quiros, Clara Esquivel, César Guillermo Lemir, Belén Palacio, Itzel L Lopez, Olmedo Villarreal, Mirta G Silva, Rosa Contreras, Carlos Gómez, Guadalupe Martínez, Gustavo Costilla Campero, Lucrecia Guaymas, Paola Romina Lazarte, Fanny Reino Choto, Hernan Vergara-Samur, M.L. González Pereyra, Johana Fernandez, Silvia Vera Amate Perez, Sandra Ferrari, Antonio Cachafeiro-Vilar, Luz S Pirra, Isabel Blanco, Nancy Sandoval, Ligia Vence Reyes, Silvia Mabel Correa, Diego M Maurizi, Hugo Videla, Leandro A Falleroni, Alejandra M Urueña, María del Carmen Bangher, Federico Romero, Graciela Sadino, Paola Carolina Correal Tovar, Carlos Garcia Cruz, Glendys Núñez, Polo Rodriguez Gonzalez, Luciana Gabriela Moya, Marisol Valle
article en
3 citations

Abstract

Abstract Background The objective of this study was 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 and February 2023. Patients >18 years of age in 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 5780 MS-ICU and 7726 Gral-ward patients. The hospitals’ median bed size (interquartile range) was 179 (125–330), and 52% were nonprofit. 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. Health care–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 therapeutic drug monitoring. In both units, 17% of antibiotics prescribed as targeted therapy represented de-escalation, while 24% and 15% in MS-ICUs and Gral-wards, 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 after the 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.

Open Forum Infectious DiseasesVol. 11(11)
Universidad de Panamá (PA), National University of Tucumán (AR), Centers for Disease Control and Prevention (US), Johns Hopkins University (US), Johns Hopkins Medicine (US), San Fernando General Hospital (TT), Hospital Italiano de Buenos Aires (AR), Hospital Punta Pacifica (PA), Dr. Lucio Meléndez Hospital Zonal General de Agudos (AR), Instituto Argentino de Diagnóstico y Tratamiento (AR), Hospital Universitario Austral (AR), San Juan City Hospital (PR), Fundació Privada Clínic per a La Recerca Biomèdica (ES), St Bernard's Hospital (GI), Hospital Militar Central (CO), Roosevelt Hospital (GT), Hospital Provincial de Rosario (AR), National Center for Emerging and Zoonotic Infectious Diseases (US), Clínica Santa María (CO), Saint Thomas Hospital (PA), Universidad Simón Bolívar (CO), Instituto Universitario de la Policía Federal Argentina (AR), Hospital Alemán (AR), Lourdes Hospital (US), Comisión Honoraria de Lucha contra el cáncer (UY), Hospital Posadas (AR), Hospital El Cruce (AR), Hospital Metropolitano (EC), Hospital Vozandes (EC), Hospital Privado (AR), Instituto Nacional de las Mujeres (MX), Hospital César Milstein (AR), Fundacion Allende (AR), Leoni (Germany) (DE)
Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry
Openalex Percentile: Top 19%
Antibiotic Use and Resistance
0.89
DOIOpen Access PDFOpenAlex
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