Clinical Impact of Antimicrobial Stewardship Programs in Colombian Acute Care Hospitals

BACKGROUND: Inappropriate use of antimicrobials contributes to antimicrobial resistance, which increases hospital length of stay, mortality and health care costs. Antimicrobial Stewardship Programs (ASP) are coordinated quality-improvement efforts to promote the judicious and effective use of antimicrobials to optimize clinical outcomes while minimizing adverse effects. The present study was designed to determine the clinical improvement of patients with healthcare associated infections (HAI) using antimicrobial stewardship policies in Colombian acute care hospitals. METHODS: We conducted a quasi-experimental study between January 2007 and December 2014 in four acute care hospitals in two Colombian cities. The study variables were evaluated two years before and two years after ASP implementation. Adult patients with HAI episodes in intensive care units or general wards were included. Clinical and economic patient outcomes were compared between groups. Data was analyzed using descriptive and inferential statistics. RESULTS: Nine hundred patients with bacterial HAIs were hospitalized in four institutions. The cohort treated before the implementation of ASPs consisted of 471 patients. The cohort treated after ASP implementation consisted of 429 patients. The median age was 62; 70% of patients had at least one comorbidity. Urinary infection was the most common infection (28%), followed by bloodstream infections (26%). After the ASP was implemented, the rate of adherence to empiric treatment clinical guidelines increased from 9% to 45%, while the rate of de-escalating increased from 8% to 92%. Multivariate analysis showed that patients receiving treatment under ASP experienced 10 times clinical improvement compared with patients not treated under ASP. Septic shock after targeted therapy was observed as an independent risk for lack of clinical improvement. Compared with the pre-ASP cohort, the post-ASP cohort experienced a shorter length of stay (10.8 vs. 14 days) and lower total infection cost ($3,307 USD vs. $4,655 USD, P < 0.001). CONCLUSION: The use of ASPs results in substantial clinical improvement in patients and contributes to fewer infection complication, shorter length of stay, and decreased costs associated with treating patients. DISCLOSURES: C. Hernández-Gómez, Merck Sharp & Dohme: Consultant, Consulting fee; Pfizer: Consultant, Consulting fee; C. Pallares, Merck Sharp & Dohme, Pfizer: Consultant, Consulting fee; M. V. Villegas, Merck Sharp & Dohme: Consultant, Consulting fee and Research support; Pfizer: Consultant, Consulting fee and Research support