Journal of Global Antimicrobial Resistance (Jun 2022)
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
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.
