Resumen:
Introducción: La implementación de Programas para la Optimización de Uso de Antimicrobianos (PROAs) ha resultado una estrategia útil para mejorar los resultados asistenciales, de manera segura y costo-efectiva, reduciendo el desarrollo de la resistencia a los antimicrobianos
Objetivo: Estimar la relación entre nivel de desarrollo de los PROAs, apropiabilidad y consumo de antimicrobianos en hospitales argentinos
Material y métodos: Entre Jul-2016 y Ene-2017, 111 hospitales condujeron una autoevaluación del nivel de desarrollo de sus PROAs usando un instrumento basado en los lineamientos del CDC (0 a 100 puntos), además de un corte de prevalencia para evaluar la apropiabilidad de las prescripciones de antimicrobianos y su consumo mensual (Dosis Diarias Definidas (DDD) c/100 días-paciente). Para la comparación de estos indicadores, los centros fueron dicotomizados tomando como punto de corte el percentilo 75 (p75) de la autoevaluación
Resultados: La comparación entre hospitales con puntaje ≥p75 vs..
Conclusiones: Aquellas instituciones con mayor puntaje en la autoevaluación presentaron mejores indicadores de apropiabilidad y consumo de antimicrobianos, reforzando la importancia de una implementación efectiva de los PROAs
Abstract:
Background: Implementation of antimicrobial stewardship (AMS) programs is considered as a useful strategy to improve clinical outcomes in a costeffective way, reducing in addition antimicrobial resistance.
Objective: To assess the association between the level of AMS programs development, appropriateness and antimicrobial consumption in Argentinean hospitals.
Material and methods: Between Jul-2016 and Jan-2017, 111 hospitals performed a self-assessment survey of their AMS programs using a standardized tool based on CDC recommendations (0–100 scale). In addition, the appropriateness of antimicrobial prescription was measured through one-day prevalence study using specific criteria. The monthly consumption of a group of antimicrobials was calculated using Defined Daily Doses (DDD) per 100 patient-days. To assess the relationship be-tween the level of AMS programs development and the appropriateness and antimi-crobial consumption indicators, participating centers were grouped into two catego-ries by using the 75th percentile (75thp) of the self-assessment score.
Results: Comparison between hospitals with score ≥75thp vs. <75thp showed significant differences in all indicators analyzed (self-assessment score: 51.6 vs. 25.4; diff. 26.2; 95%CI 30.3 to 22.0, p<0.000; surgical prophylaxis: ≤ 24 hs 64.8% vs. 52.3%; diff. 12.5%; 95%CI 5.1% to 20.0%, p<0.002; compliance with guidelines: 77.6% vs. 47.0%; diff. 30.6%; 95%CI 28.1% to 33.0%, p<0.000; prospective audit with feedback: 69.4% vs. 46.8%; diff. 22.6%; 95%CI 20.0% to 25.2%, p<0.000; antimicrobial consumption: 114.8 DDDs vs. 259.2 DDDs; diff.–144.4; 95%CI –140.6 to –148.2, p<0.000)
Conclusions: Hospitals with higher selfassessment score showed better appropriateness and consumption antimicrobial indicators, reinforcing the relevance of an effective implementation of AMS programs.
Keywords:
optimización del uso de antimicrobianos, dosis diarias definidas, autoevaluación, estudio multicéntrico, estudio de corte transversal, Antimicrobial stewardship, Defined Daily Doses, self-assessment, multicenter study, cross sectional study
