Rodolfo Quiros

Background: Antimicrobial resistance (AMR) is a major global health threat, with a disproportionate impact on low- and middle-income countries. The TEACH PROA-ECHO (Telementoring, Equity & Advocacy Collaboration for Health through Antimicrobial Stewardship) initiative aimed to strengthen antimicrobial stewardship programs (ASPs) in Latin America using the ECHO telementoring model. Methods: From March to December 2024, 80 healthcare institutions from 10 Latin American countries participated in biweekly telementoring sessions focused on case-based learning guidance on stewardship interventions and collaborative problem-solving related to antimicrobial prescribing and surveillance. A validated self-assessment tool was used to categorize baseline ASP development and monitor progress over time. Learning activities were evaluated using Moore's framework, and participating teams identified local barriers and enablers for stewardship activities. Results: Of the 80 institutions, 73 (91%) completed the program. A total of 322 professionals were registered in the project, accounting for 2166 attendances. Moore's indicators showed high satisfaction (Net Promoter Score 79) and significant knowledge improvement after sessions (97.3% vs 81.4%; P < .0001). Mean ASP self-assessment scores increased from 53.1 to 64.0 (P < .0001). The proportion of institutions with intermediate or advanced ASP development rose from 56.2% to 83.6% (P < .001). Higher baseline scores were associated with for-profit institutions, ASP implementation longer than 5 years, and program continuity (lack of ASP interruptions in the last 5 years). Conclusions: Telementoring is an effective and scalable approach to strengthening antimicrobial stewardship in Latin America. The TEACH PROA-ECHO model represents a valuable strategy to support national AMR action plans in resource-limited settings.

Introducción: el concepto “Una Salud” instaurado por la Organización Mundial de la Salud, hace referencia a la importancia del enfoque global acerca de la salud humana, animal y del medio ambiente. La interrelación existente entre ellos no puede quedar ajena al manejo de las enfermedades del ser humano. Por otro lado, la resistencia antimicrobiana es un problema mundial cada vez mayor en todos los ámbitos y es responsabilidad de los gobiernos una pronta iniciativa en pos de evitar la perpetuidad de esta problemática. Objetivo: investigar cómo se descartan los antimicrobianos en el ámbito domiciliario de la ciudad de Concordia en el año 2022. Metodología: en el estudio se utilizó un enfoque cuantitativo a través de encuestas estructuradas específicas no autoadministradas en una muestra no probabilística de la población de la ciudad de Concordia. Para el análisis de los datos recopilados, se aplicó estadística descriptiva, lo que permitió obtener frecuencias absolutas y relativas de cada variable medida en el estudio. Resultados: los resultados indican que, en cuanto a los antibióticos, la mayoría de la población los descarta en la basura o los tira al inodoro, y un porcentaje considerable no se fija en la fecha de vencimiento o los usa por un tiempo más después de su vencimiento. Estos hallazgos resaltan la necesidad de una mayor conciencia y educación sobre el manejo adecuado de los medicamentos vencidos y los antibióticos. Conclusiones: existen importantes falencias en cuanto a los conocimientos generales de la población respecto al uso adecuado de este tipo de medicamentos, de los conceptos básicos inherentes a los riesgos de su consumo innecesario y de la forma en que se desechan los mismos.

Background: There is limited knowledge on the extent of antimicrobial stewardship program (ASP) implementation in health care facilities (HCFs) in Latin America. Methods: We performed an evaluation of ASPs in Latin American HCFs from March 2022 to February 2023 using a structured self-assessment survey associated with a scoring system that evaluated leadership support and accountability, resources, antibiotic stewardship actions, education, and antibiotic use (AU) monitoring and reporting. Additionally, we collected monthly AU data (antibiotic consumption and point prevalence surveys) and number of multidrug-resistant infections in medical-surgical intensive care units. Self-assessment scores were correlated with AU through multivariable regression models adjusting for bed size, country of HCF, and incidence of infections (when appropriate). Results: Of the 39 HCFs recruited for the study, all completed the self-assessment, 36 performed the point prevalence survey, and 29 collected antibiotic consumption data. The overall median self-assessment score was 252.5 (IQR, 212.5–285) for a maximum possible score of 335. A high self-assessment score (top quartile) was associated with higher guideline-compliant AU (odds ratio [OR], 8.63; 95% CI, 3.03–24.6; P < .001), higher use of directed therapy (OR, 2.11; 95% CI, 1.41–3.1; P < .001), and less consumption of anti–methicillin-resistant Staphylococcus aureus agents (OR, −8.59; SE = 4.12; P = .037) after adjusting for bed size, country, and incidence of methicillin-resistant S aureus infections. Conclusions: Higher-level ASP implementation in Latin American HCFs correlated with better compliance with AU guidelines and decreased the use of vancomycin in the intensive care unit, supporting the need to improve resources for ASPs.

Background: Infection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown. Methods: We conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively. Results: Thirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators. Conclusions: Efforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

The objective of this study was to identify antibiotic stewardship (AS) opportunities in Latin American medical–surgical intensive care units (MS-ICUs) and general wards (Gral-wards). We conducted serial cross-sectional point prevalence surveys in MS-ICUs and Gral-wards in 41 Latin American hospitals between March 2022 and February 2023. Patients >18 years of age in the units of interest were evaluated for antimicrobial use (AU) monthly (MS-ICUs) or quarterly (Gral-wards). Antimicrobial data were collected using a standardized form by the local AS teams and submitted to the coordinating team for analysis. We evaluated AU in 5780 MS-ICU and 7726 Gral-ward patients. The hospitals’ median bed size (interquartile range) was 179 (125–330), and 52% were nonprofit. The aggregate AU prevalence was 53.5% in MS-ICUs and 25.5% in Gral-wards. Most (88%) antimicrobials were prescribed to treat infections, 7% for surgical prophylaxis and 5% for medical prophylaxis. Health care–associated infections led to 63% of MS-ICU and 38% of Gral-ward AU. Carbapenems, piperacillin-tazobactam, intravenous (IV) vancomycin, and ampicillin-sulbactam represented 50% of all AU to treat infections. A minority of IV vancomycin targeted therapy was associated with documented methicillin-resistant Staphylococcus aureus infection or therapeutic drug monitoring. In both units, 17% of antibiotics prescribed as targeted therapy represented de-escalation, while 24% and 15% in MS-ICUs and Gral-wards, respectively, represented an escalation of therapy. In Gral-wards, 32% of antibiotics were used without a microbiologic culture ordered. Half of surgical prophylaxis antibiotics were prescribed after the first 24 hours. Based on this cohort, areas to improve AU in Latin American hospitals include antibiotic selection, de-escalation, duration of therapy, and dosing strategies.

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.

Background: Antimicrobial resistance has worsened in Latin America. There is an urgent need to understand the development of antimicrobial stewardship programs (ASPs) and the barriers to implementing effective ASPs in light of limited national action plans or policies to promote ASPs in the region. Methods: We performed a descriptive mixed-methods study of ASPs in 5 Latin American countries in March-July 2022. An electronic questionnaire with an associated scoring system (hospital ASP self-assessment) was used, and ASP development was classified based on the scores (inadequate, 0–25; basic, 26–50; intermediate, 51–75; or advanced, 76–100). Interviews among healthcare workers (HCWs) involved in antimicrobial stewardship (AS) inquired about behavioral and organizational factors that influence AS activities. Interview data were coded into themes. Results from the ASP self-assessment and interviews were integrated to create an explanatory framework. Results: Twenty hospitals completed the self-assessment, and 46 AS stakeholders from these hospitals were interviewed. ASP development was inadequate/basic in 35% of hospitals, intermediate in 50%, and advanced in 15%. For-profit hospitals had higher scores than not-for-profit hospitals. Interview data validated the self-assessment findings and provided further insight into ASP implementation challenges, which included limited formal hospital leadership support, inadequate staffing and tools to perform AS work more efficiently, limited awareness of AS principles by HCWs, and limited training opportunities. Conclusions: We identified several barriers to ASP development in Latin America, suggesting the need to create accurate business cases for ASPs to obtain the necessary funding for their effective implementation and sustainability.

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.

Objective: To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical–surgical intensive care units (MS-ICUs) in Latin America.Design: Quasi-experimental prospective with continuous time series.Setting: The study included 77 MS-ICUs in 9 Latin American countries.Patients: Adult patients admitted to an MS-ICU for at least 24 hours were included in the study.Methods: This multicenter study was conducted over 12 months. To evaluate the ASPs, representatives from all MS-ICUs performed a self-assessment survey (0–100 scale) at the beginning and end of the study. The impact of each ASP was evaluated monthly using the following measures: antimicrobial consumption, appropriateness of antimicrobial treatments, crude mortality, and multidrug-resistant microorganisms in healthcare-associated infections (MDRO-HAIs). Using final stewardship program quality self-assessment scores, MS-ICUs were stratified and compared among 3 groups: ≤25th percentile, >25th to P < .0001). Several indicators performed better in the MS-ICUs in the 75th versus 25th percentiles: antimicrobial consumption (143.4 vs 159.4 DDD per 100 patient days; P < .0001), adherence to clinical guidelines (92.5% vs 59.3%; P < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; P < .0001), crude mortality (15.9% vs 17.7%; P < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; P = .004).Conclusion: MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.