Relationship between the antimicrobial stewardship program development, appropriateness and antimicrobial consumption in Argentinean hospitals

Abstract

Objective: To assess the association between the level of AMS programs development, appropriateness and antimicrobial consumption in Argentinean hospitals
Material and methods: Between Jul-2016 and Jan-2017, 111 hospitals performed a self-assessment survey of their AMS programs using a standardized tool based on CDC recommendations (0–100 scale). In addition, the appropriateness of antimicrobial prescription was measured through one-day prevalence study using specific criteria. The monthly consumption of a group of antimicrobials was calculated using Defined Daily Doses (DDD) per 100 patient-days. To assess the relationship between the level of AMS programs development and the appropriateness and antimicrobial consumption indicators, participating centers were grouped into two categories by using the 75th percentile (75thp) of the self-assessment score

Results: Comparison between hospitals with score ≥75thp vs <75thp showed significant differences in all indicators analyzed (self- assessment score: 51.6 vs 25.4; diff. 26.2; 95%CI 30.3 to 22.0, p<0.000; surgical prophylaxis: ≤ 24 hs 64.8% vs 52.3%; diff. 12.5%; 95%CI 5.1% to 20.0%, p<0.002; compliance with guidelines: 77.6% vs 47.0%; diff. 30.6%; 95%CI 28.1% to 33.0%, p<0.000; prospective audit with feedback: 69.4% vs 46.8%; diff. 22.6%; 95%CI 20.0% to 25.2%, p<0.000; antimicrobial consumption: 114.8 DDDs vs 259.2 DDDs; diff.–144.4; 95%CI –140.6 to –148.2, p<0.000)

Conclusions: Hospitals with higher self-assessment score showed better appropriateness and consumption antimicrobial indicators, reinforcing the relevance of an effective implementation of AMS programs

Keywords: HIV, Antimicrobial stewardship, Defined Daily Doses, self- assessment, multicenter study, cross sectional study.