Didia Sagastume

Background: Antibiotic overuse in hospitals is common and linked to adverse outcomes and antimicrobial resistance. Antimicrobial stewardship programs (ASP) aim to optimize prescribing and require context-specific adaptation. Objectives: To describe the experience of implementing and strengthening ASP in hospitals from six Latin American countries by using an integrated framework. Methods: The intervention included a point-prevalence survey (PPS) of antibiotic use, a baseline checklist, a continuous online education program, and individual facility meetings to share SWOT analyses and recommendations. The latter was performed based on PPS and checklist results. The checklist covers six domains (authorities’ commitment, organization, structure, and accountability; interventions; education and training; monitoring and surveillance; and internal communication). The training program spanned 12–18 months and addressed core ASP components. Results: The PPS across 67 hospitals showed an antibiotic use prevalence of 47.9%, with 63% of prescriptions deemed appropriate. The median checklist score was 61.2%. Among the categories assessed, monitoring and surveillance achieved the highest score (median 75.0; IQR 63.9–84.0), while education received the lowest (median 43.8; IQR 29.7–62.5). A total of 80 country groups and 35 individual hospital meetings were held. Conclusions: An integrated, data-driven framework combining PPS, checklists, individual hospital meetings, and sustained training provides a scalable approach to strengthening ASP in diverse Latin American hospitals, aligning with Pan American Health Organization (PAHO) guidance and global recommendations.

Background: Antimicrobial resistance (AMR) is a public health challenge, exacerbated by the inappropriate use of antibiotics (ABs) and the lack of standardized surveillance in healthcare settings. Objective: The Latin American PPS aimed to provide a standardized methodology for monitoring antibiotic use, gather data on antibiotic prescription practices, and support initiatives for antimicrobial stewardship (AMS). Methodology: Using a Spanish-adapted version of the WHO PPS methodology, a point prevalence survey (PPS) was conducted between 2022 and 2023 in 67 hospitals across five Latin American countries. Results: A total of 11,094 patients were surveyed, of which 47.9% received at least one AB; surgical and intensive care units displayed the highest prevalence. Most prescribed AB were third-generation cephalosporins (3GC) (22.0%), carbapenems (12.1%), glycopeptides (9.2%), and penicillin combinations (8.6%). A substantial use of agents classified under the WHO’s “Watch” group was found, with notable variances across countries. A multilevel logistic regression model identified that patient age, ICU admission, recent hospitalization, the presence of a catheter, and intubation were significantly associated with higher odds of AB use. In contrast, patients admitted to obstetric or pediatric wards had lower odds of receiving antibiotics. The model revealed considerable heterogeneity between countries, even after adjusting clinical and demographic factors. Conclusions: This study highlights AMS opportunities through targeted interventions, such as optimizing surgical prophylaxis, reducing the use of 3GC, carbapenems, and glycopeptides, and improving adherence to CPGs. These findings provide a comprehensive framework for policymakers and healthcare facilities to develop AMS strategies tailored to the Latin American context.