Browsing by Autor "Valeria Fabre"

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1765. Antibiotic Consumption in a Healthcare System in Bolivia During the First Wave of COVID-19 Pandemic
(Oxford University Press, 2022) Rodolfo E Quiros; Elvio D. Escobar; Juan Carlos Tapia; Valeria Fabre
Abstract Background Several countries in Latin America reported an increase in antibiotic use during the first wave of the COVID-19 Pandemic. Methods We retrospectively evaluated antibiotic use among 10,752 members of a private healthcare system in Santa Cruz de la Sierra, Bolivia, between Jan-Dec 2019 (pre-pandemic) and Jan-Aug 2020 (pandemic). Antibiotic use was calculated as daily defined doses (DDD) per 1,000 member-days, per 100 ambulatory visits, and per 100 inpatient-days, and categorized using the World Health Organization classification (Access, Watch, and Reserve), based on the impact of different antibiotics on antimicrobial resistance. In April 2020, the antibiotic stewardship team developed COVID-19 treatment guidelines for ambulatory and hospitalized patients and provided recommendations on all patients hospitalized due to COVID-19. Due to the nature of the network, guideline use is usually high. During the pandemic period and due to local restrictions, patient interactions were mostly limited to COVID-19 presentations. Differences with 95% confidence intervals (CI) between groups were estimated. Results Pandemic and pre-pandemic antibiotic use in DDD/1,000 member-days was 8.48 and 18.37, respectively (diff. –8.89, 95%CI –10.11 to –9.67). Outpatient DDD/100 ambulatory visits was 67.68 vs. 86.20 (diff. –18.52, 95%CI –19.94 to –17.1), and hospital DDD/per 100 inpatient-days was 39.79 vs. 61.71 (diff. –21.92, 95%CI –26.2 to –17.68) for pandemic and pre-pandemic periods, respectively. During the pandemic period, an overall reduction in macrolides use was also observed (–3.13 DDD/100 ambulatory visits, 95%CI –3.84 to –2.44, and –2.05 DDD/per 100 inpatient-days, 95%CI –2.88 to –1.26). Additionally, an increase in Access antimicrobials (83.3% vs. 79.5%; diff. 3.8%, 95%CI 0.3% to 7.4%) and a reduction in the Watch group (16.7% vs. 20.5%; diff. –3.7%, 95%CI –7.4% to –0.1%) were observed for pandemic and pre-pandemic periods, respectively. Conclusion In this closed network, we observed a reduction in antibiotic use both in ambulatory and inpatient settings. Although, multifactorial, we believe the enhanced antibiotic stewardship approach on COVID-19 patients played a role in limiting antimicrobial use in this private healthcare system. Disclosures All Authors: No reported disclosures.
1793. Evaluation of Ambulatory Antibiotic Use in Children and Adult Patients of a Healthcare System in Bolivia Using the AWaRe Classification
(Oxford University Press, 2022) Rodolfo E Quiros; Elvio D. Escobar; Juan Carlos Tapia; Sara E. Cosgrove; Valeria Fabre
Abstract Background The World Health Organization (WHO) has established the AWaRe (Access, Watch and Reserve) classification based on the impact of different antibiotics on antimicrobial resistance. For ambulatory patients, WHO recommends Access antibiotics to represent &gt;60% of all prescriptions, and an Access to Watch (AW) index of ≥1.5. The use of Access and Watch antibiotics has not been evaluated in ambulatory patients in Latin America. The aim of this study was to describe antibiotic use among members of two health plans within a private health insurance in Bolivia. Methods We retrospectively evaluated antibiotic use among 8,405 members of a private healthcare system in Santa Cruz de la Sierra, Bolivia, between Jan-2017 and Dec-2018. Antibiotic use was calculated as defined daily doses (DDD) per 1,000 member-days, and compared between two plans, one a Health Maintenance Organization (HMO) (2,419 members) and the other a Preferred Provider Organization (PPO) (5,986 members). In the HMO plan, members have a general practitioner (GP) as the primary point of care, whereas in the PPO plan, members can access specialists directly without a referral from the GP. Differences between groups were calculated using Byar test with 95% confidence intervals (CI). Results Antibiotic use in DDD/1,000 member-days for the study period was 8.31 in ambulatory, 10.7 in the Emergency Department, and 0.72 in the hospital. Ambulatory antibiotic use in the HMO plan was lower than the PPO plan (6.95 vs. 8.89 DDD/1,000 member-days; diff. –1.94, 95%CI –2.15 to –1.72) (Table). Of all ambulatory antibiotics, 55% were Access and 45% were Watch (AW index: 1.24). By patient group, 52% of pediatric and 58% of adult prescriptions were Access; diff. –6%; p&lt; 0.001 (AW index: 1.07 and 1.39, respectively). By health plan, 62% of HMO and 53% of PPO antibiotics were Access; diff. 9%; p&lt; 0.001 (AW index: 1.13 and 1.67, respectively). Conclusion Ambulatory antibiotic use in this cohort was high. Overall use of Access antibiotics was lower than the recommended by WHO; however, we found less broad-spectrum antibiotic use in the HMO plan compared to the PPO plan. These findings highlight the urgent need for antibiotic stewardship in the ambulatory setting, and the important role of GPs in appropriate antibiotic prescribing. Disclosures Sara E. Cosgrove, MD, Basilea: Member of Infection Adjudication Committee.
Ambulatory Antibiotic Use Patterns in Bolivia: Identifying Targets for Future Antibiotic Stewardship Efforts in Latin America
(Cambridge University Press, 2023) Rodolfo Quirós; Maria E. Mesalles; Elvio D. Escobar; Juan Carlos Tapia Torrez; Sara E. Cosgrove; Valeria Fabre
We evaluated antibiotic use in a private health insurance network in Bolivia with two different healthcare plans. The Health Maintenance Organization plan had 29% lower antibiotic consumption and fewer broad-spectrum antibiotics prescribed than the Preferred Provider Organization. Furthermore, we identified potential targets for future antibiotic stewardship efforts.
Antimicrobial stewardship in Latin America: Past, present, and future
(Cambridge University Press, 2022) Valeria Fabre; Sara E. Cosgrove; Clara Secaira; Juan Carlos Tapia Torrez; Fernanda C. Lessa; Twisha S Patel; Rodolfo Quirós
Implementation of antimicrobial stewardship programs (ASPs) in well-resourced countries has been associated with reductions in antibiotic-resistant infections and improved patient outcomes. Several guidance documents providing recommendations on how to structure antimicrobial stewardship activities at the national and hospital level in resource-limited settings have been published. However, few hospitals in Latin America report having a structure or resources needed for a successful ASP. Given the alarming increases in antimicrobial resistance in Latin America, better understanding of barriers to promote implementation of effective ASPs is urgently needed. We have summarized past and present antimicrobial stewardship activities in Latin American hospitals, and we describe key elements needed in future efforts to strengthen antimicrobial stewardship in the region.