904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.

BACKGROUND: In a recent report from Latin American hospitals, only 59.7% of the prescriptions of patients admitted to the ICU followed treatment guidelines. Implementation of antimicrobial stewardship programs (AMS) have proven to be an effective tool for the rational use of antimicrobials, but thei...

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Autores principales: Díaz-Madriz, José Pablo, Zavaleta-Monestel, Esteban, Chaverri-Fernandez, José Miguel, Arguedas-Chacón, Sebastián, Arguedas-Herrera, Raquel, Leiva-Montero, Brayan, Vásquez-Mendoza, Ana Fernanda, Muñoz-Gutierrez, Gabriel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751641/
http://dx.doi.org/10.1093/ofid/ofac492.749
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author Díaz-Madriz, José Pablo
Zavaleta-Monestel, Esteban
Chaverri-Fernandez, José Miguel
Arguedas-Chacón, Sebastián
Arguedas-Herrera, Raquel
Leiva-Montero, Brayan
Vásquez-Mendoza, Ana Fernanda
Muñoz-Gutierrez, Gabriel
author_facet Díaz-Madriz, José Pablo
Zavaleta-Monestel, Esteban
Chaverri-Fernandez, José Miguel
Arguedas-Chacón, Sebastián
Arguedas-Herrera, Raquel
Leiva-Montero, Brayan
Vásquez-Mendoza, Ana Fernanda
Muñoz-Gutierrez, Gabriel
author_sort Díaz-Madriz, José Pablo
collection PubMed
description BACKGROUND: In a recent report from Latin American hospitals, only 59.7% of the prescriptions of patients admitted to the ICU followed treatment guidelines. Implementation of antimicrobial stewardship programs (AMS) have proven to be an effective tool for the rational use of antimicrobials, but their implementation has been a challenge in this region due to resources limitations. One significant barrier is the lack of clinical pharmacists with specialized training in infectious diseases. This study aims to determine the impact of a pharmacy driven AMS on the optimal prophylactic and empirical therapy prescription by intensive care physicians (ICP) in a Latin American hospital. METHODS: A retrospective observational study that compared the optimal selection and the consumption (DOTs/1000 ICP patient days) of antibiotics in patients treated by intensive care physicians before and after the implementation of the AMS at Clínica Biblica Hospital, Costa Rica. The comparison was made from January to December 2014 (preAMS) and from January 2020 to March 2021 (postAMS). Bacterial resistance patterns before and after AMS implementation were also compared. RESULTS: A total of 333 patients met the inclusion criteria (52% preAMS and 48% postAMS). After a five-year intervention, the optimal antibiotic selection prescribed by ICP was 43.1% (n=75) in the preAMS period and 86.8% (n=138) in the postAMS period (43.7% absolute improvement, p < 0.001). The prescription of most antibiotics showed an improvement (Fig 1), such as ertapenem in 45% (p< 0.001) and levofloxacin in 59% (p< 0.001). Similarly, there was a trend towards improvement of the prescription by diagnosis (Fig 2), including an increase of 32% (p< 0.001) in CAP. There was a reduction of the consumption of most antimicrobials (Fig 3) including a decrease of 66.9% (p =0.017) for vancomycin and 64.7% (p =0.033) for meropenem. Regarding bacterial resistance, there was found a decrease of 11% (p=0.048) of P. aeruginosa resistant to meropenem and a reduction in the detection of ESBL in E. coli (11% decrease; p=0.007). [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: The AMS implementation showed an overall positive impact on antibiotics selection and consumption. In addition, is thought that the intervention could had a positive effect on antibiotic resistance. DISCLOSURES: José Pablo Díaz-Madriz, PharmD, MSc, Eli Lilly: Stocks/Bonds|Pfizer: Advisor/Consultant.
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spelling pubmed-97516412022-12-16 904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital. Díaz-Madriz, José Pablo Zavaleta-Monestel, Esteban Chaverri-Fernandez, José Miguel Arguedas-Chacón, Sebastián Arguedas-Herrera, Raquel Leiva-Montero, Brayan Vásquez-Mendoza, Ana Fernanda Muñoz-Gutierrez, Gabriel Open Forum Infect Dis Abstracts BACKGROUND: In a recent report from Latin American hospitals, only 59.7% of the prescriptions of patients admitted to the ICU followed treatment guidelines. Implementation of antimicrobial stewardship programs (AMS) have proven to be an effective tool for the rational use of antimicrobials, but their implementation has been a challenge in this region due to resources limitations. One significant barrier is the lack of clinical pharmacists with specialized training in infectious diseases. This study aims to determine the impact of a pharmacy driven AMS on the optimal prophylactic and empirical therapy prescription by intensive care physicians (ICP) in a Latin American hospital. METHODS: A retrospective observational study that compared the optimal selection and the consumption (DOTs/1000 ICP patient days) of antibiotics in patients treated by intensive care physicians before and after the implementation of the AMS at Clínica Biblica Hospital, Costa Rica. The comparison was made from January to December 2014 (preAMS) and from January 2020 to March 2021 (postAMS). Bacterial resistance patterns before and after AMS implementation were also compared. RESULTS: A total of 333 patients met the inclusion criteria (52% preAMS and 48% postAMS). After a five-year intervention, the optimal antibiotic selection prescribed by ICP was 43.1% (n=75) in the preAMS period and 86.8% (n=138) in the postAMS period (43.7% absolute improvement, p < 0.001). The prescription of most antibiotics showed an improvement (Fig 1), such as ertapenem in 45% (p< 0.001) and levofloxacin in 59% (p< 0.001). Similarly, there was a trend towards improvement of the prescription by diagnosis (Fig 2), including an increase of 32% (p< 0.001) in CAP. There was a reduction of the consumption of most antimicrobials (Fig 3) including a decrease of 66.9% (p =0.017) for vancomycin and 64.7% (p =0.033) for meropenem. Regarding bacterial resistance, there was found a decrease of 11% (p=0.048) of P. aeruginosa resistant to meropenem and a reduction in the detection of ESBL in E. coli (11% decrease; p=0.007). [Figure: see text] [Figure: see text] [Figure: see text] CONCLUSION: The AMS implementation showed an overall positive impact on antibiotics selection and consumption. In addition, is thought that the intervention could had a positive effect on antibiotic resistance. DISCLOSURES: José Pablo Díaz-Madriz, PharmD, MSc, Eli Lilly: Stocks/Bonds|Pfizer: Advisor/Consultant. Oxford University Press 2022-12-15 /pmc/articles/PMC9751641/ http://dx.doi.org/10.1093/ofid/ofac492.749 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Díaz-Madriz, José Pablo
Zavaleta-Monestel, Esteban
Chaverri-Fernandez, José Miguel
Arguedas-Chacón, Sebastián
Arguedas-Herrera, Raquel
Leiva-Montero, Brayan
Vásquez-Mendoza, Ana Fernanda
Muñoz-Gutierrez, Gabriel
904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.
title 904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.
title_full 904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.
title_fullStr 904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.
title_full_unstemmed 904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.
title_short 904. Impact of a Pharmacist-driven Antimicrobial Stewardship Program on Prescribing Practices by Intensive Care Physicians in a Latin American Hospital.
title_sort 904. impact of a pharmacist-driven antimicrobial stewardship program on prescribing practices by intensive care physicians in a latin american hospital.
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751641/
http://dx.doi.org/10.1093/ofid/ofac492.749
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