Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations
ABSTRACT: Objectives: Ecuador is a lower-to-middle-income country not yet adherent to World Health Organization (WHO) antibiotic stewardship strategies, and data regarding basic metrics are still lacking. Methods: We conducted a retrospective study of an antibiotic stewardship programme (ASP) consi...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Journal of Global Antimicrobial Resistance |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716521002514 |
| _version_ | 1817969648370450432 |
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| author | Hugo Fernando Romo-Castillo, PhD, MD Antonio Pazin-Filho, PhD, MD, MBA |
| author_facet | Hugo Fernando Romo-Castillo, PhD, MD Antonio Pazin-Filho, PhD, MD, MBA |
| author_sort | Hugo Fernando Romo-Castillo, PhD, MD |
| collection | DOAJ |
| description | ABSTRACT: Objectives: Ecuador is a lower-to-middle-income country not yet adherent to World Health Organization (WHO) antibiotic stewardship strategies, and data regarding basic metrics are still lacking. Methods: We conducted a retrospective study of an antibiotic stewardship programme (ASP) consisting of restrictive measures on carbapenem dispensing pending required pre-authorisation and expert audit. We evaluated antibiotic consumption and its relationship to carbapenem resistance at a 610-bed, tertiary-level hospital in Quito, Ecuador. We used prescription data from 2010–2017 and converted them into defined daily doses (DDD). We then correlated these findings with the nature of service provided and antibiotic resistance data from the microbiology laboratory. We used descriptive statistics and interrupted time series (ITS) analysis. Results: Throughout the study period, we analysed 16 984 355 prescriptions of 8 191 418.57 g of antibiotics (5 760 479.37 DDD). The in-hospital mean antibiotic prescription rate was 148.8 ± 14.8 DDD/100 occupied bed-days and 293.5 ± 65.3 DDD/100 occupied bed-days in the ICU. First-, second- and third-line antibiotic consumption was 38%, 52% and 10%, respectively. Our hospital data showed a high rate of antibiotic prescription in all hospital areas, mainly broad-spectrum antibiotics. Regarding the ASP introduced in 2016, ITS analysis showed a change in the outcome level immediately following the introduction for imipenem [–3.97; 95% confidence interval (CI) –5.31 to –2.61] but not for meropenem (0.66; 95% CI –0.37 to 1.71). Conclusion: Although our institution's ASP was successful in reducing imipenem consumption, a more embracing plan is required for further interventions to avoid unexpected effects. |
| first_indexed | 2024-04-13T20:24:38Z |
| format | Article |
| id | doaj.art-75053f725eca43ab85c83ee05d2eaee8 |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-04-13T20:24:38Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-75053f725eca43ab85c83ee05d2eaee82022-12-22T02:31:25ZengElsevierJournal of Global Antimicrobial Resistance2213-71652022-06-0129462467Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendationsHugo Fernando Romo-Castillo, PhD, MD0Antonio Pazin-Filho, PhD, MD, MBA1Department of Pharmacology, Universidad Central del Ecuador, Hospital Carlos Andrade Marín (IESS),Quito, EcuadorInternal Medicine Department, Ribeirao Preto Medical School, University of São Paulo, SP, Brazil; Corresponding author. Mailing address: Rua do Professor, 600 apto 143 Ribeirão Preto – SP – Brazil – 14020-280. Tel.: +55 16 99609 0321.ABSTRACT: Objectives: Ecuador is a lower-to-middle-income country not yet adherent to World Health Organization (WHO) antibiotic stewardship strategies, and data regarding basic metrics are still lacking. Methods: We conducted a retrospective study of an antibiotic stewardship programme (ASP) consisting of restrictive measures on carbapenem dispensing pending required pre-authorisation and expert audit. We evaluated antibiotic consumption and its relationship to carbapenem resistance at a 610-bed, tertiary-level hospital in Quito, Ecuador. We used prescription data from 2010–2017 and converted them into defined daily doses (DDD). We then correlated these findings with the nature of service provided and antibiotic resistance data from the microbiology laboratory. We used descriptive statistics and interrupted time series (ITS) analysis. Results: Throughout the study period, we analysed 16 984 355 prescriptions of 8 191 418.57 g of antibiotics (5 760 479.37 DDD). The in-hospital mean antibiotic prescription rate was 148.8 ± 14.8 DDD/100 occupied bed-days and 293.5 ± 65.3 DDD/100 occupied bed-days in the ICU. First-, second- and third-line antibiotic consumption was 38%, 52% and 10%, respectively. Our hospital data showed a high rate of antibiotic prescription in all hospital areas, mainly broad-spectrum antibiotics. Regarding the ASP introduced in 2016, ITS analysis showed a change in the outcome level immediately following the introduction for imipenem [–3.97; 95% confidence interval (CI) –5.31 to –2.61] but not for meropenem (0.66; 95% CI –0.37 to 1.71). Conclusion: Although our institution's ASP was successful in reducing imipenem consumption, a more embracing plan is required for further interventions to avoid unexpected effects.http://www.sciencedirect.com/science/article/pii/S2213716521002514Inpatient utilisationATC/DDD methodologyDrug consumptionInterrupted time seriesLower-to-middle income countriesAntibiotic stewardship |
| spellingShingle | Hugo Fernando Romo-Castillo, PhD, MD Antonio Pazin-Filho, PhD, MD, MBA Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations Journal of Global Antimicrobial Resistance Inpatient utilisation ATC/DDD methodology Drug consumption Interrupted time series Lower-to-middle income countries Antibiotic stewardship |
| title | Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations |
| title_full | Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations |
| title_fullStr | Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations |
| title_full_unstemmed | Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations |
| title_short | Towards implementing an antibiotic stewardship programme (ASP) in Ecuador: evaluating antibiotic consumption and the impact of an ASP in a tertiary hospital according to World Health Organization (WHO) recommendations |
| title_sort | towards implementing an antibiotic stewardship programme asp in ecuador evaluating antibiotic consumption and the impact of an asp in a tertiary hospital according to world health organization who recommendations |
| topic | Inpatient utilisation ATC/DDD methodology Drug consumption Interrupted time series Lower-to-middle income countries Antibiotic stewardship |
| url | http://www.sciencedirect.com/science/article/pii/S2213716521002514 |
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