Implementation of Antimicrobial Stewardship Programs in Adult Intensive Care Units and General Wards at Argentinean Hospitals: The PROA Project

Abstract

Background: Background: Implementation of antimicrobial stewardship (AMS) programs is considered as a useful strategy in order to improve clinical outcomes in a cost-effective way, reducing in addition antimicrobial resistance. The aim of this study was to determine the impact of AMS programs at institutional level in Argentinean hospitals Methods & Materials: Material and methods: Since Jul-2016 a multicenter study (PROA Project) was launched in Argentina. One-hundred eleven centers enter into the project. Until October-2017, twenty-five hospitals completed the twelve months of the study. All centers performed a self-assessment survey of their AMS programs using a standardized tool based on CDC recommendations (0–100 scale) at the beginning and at the end of the study. Additionally, the appropriateness of antimicrobial prescription was measured as a percentage of total prescriptions through four one-day prevalence surveys using specific criteria. The consumption of a group of antimicrobials was calculated monthly using Defined Daily Doses (DDD) adjusted by 100 patient-days Results: Results: Although the initial score was low in these centers, all improved along the study (27.8 ± 16.3 vs 38.9 ± 18.8; diff. 11.2 95%CI 6.1 a 16.3; p = 0.0001). Additionally, we also found a significant improvement in the indicators analyzed when the first two prevalence surveys were compared with the last two (registration in the clinical record 81.0% vs88.3%; diff. 7.3%; 95%CI 4.9% to 9.6%; p < 0.000; compliance with clinical guidelines 47.8% vs 59.1%; diff. 11.3%; 95%CI 8.0% to 14.6%; p < 0.000; prospective audit with feedback 46.4% vs 59.1%; diff. 12.7%; 95%CI 9.4% to 16.0%, p < 0.000; antimicrobial consumption 126.7 DDDs vs 100.3 DDDs; diff.–26.4 95%CI–25.5 to–27.4; p < 0.000). Only surgical prophylaxis ≤ 24 hs did not show a significant improvement (59.0% vs 64.0%; diff. 5.0%; 95%CI -3.0% to 13.0%, p = NS). Those hospitals with initial score above the 50th percentile, showed higher improvements Conclusion: Conclusions: The implementation of AMS programs, at institutional level in Argentinean hospitals, allowed to improve the appropriateness indicators associated with antimicrobial prescriptions