Core Elements of Hospital Antibiotic Stewardship Programs: An Evaluation in Seven Colombian Hospitals

Background: Education in Antibiotic Stewardship Programs (AMSP) in Colombia has motivated the implementation of AMSP in hospitals. The objective was to audit the AMSP in high complexity hospitals in six Colombian cities in order to develop specific actions to meet the AMSP goals.

Methods: Cross-sectional study conducted between January and May of 2016. Seven 200- to 800-bed hospitals were included. The staff of the hospital-acquired infections committee responsible for the AMSP was interviewed and the basis of the aspects included in the Core Elements of Hospital Antibiotic Stewardship: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education) was verified. The frequency of the results was described.

Results: forty-three per cent of hospitals had a formal, written statement of support and 14% received financial support. One hospital had a single leader in charge of AMSP and two hospitals had pharmacist leaders responsible for improving antibiotic use. Other members of the AMSP staff included clinicians, epidemiologists, and microbiologists (43%), information technologists (29%), and quality improvement personnel and nurse practitioners (14%). None of the hospitals had a clearly defined AMSP policy; 57% considered local epidemiology to make recommendations for antibiotic use (ATB). Twenty-nine per cent pre-approved the use of ATB, while 14% conducted prescription audits; only one hospital performed adjustments in cases of organ dysfunction; 100% met the indication of performing cultures in invasive infections and 43% used strategies to ensure ATB treatment in urinary tract infections. Neither process measures nor track of C. difficileinfection were registered; 43% had an ATB susceptibility report, and in 57%, ATB use was monitored through defined daily dose. Twenty-nine per cent directly informed the report of ATB use to prescribers, and 43% included anti-microbial susceptibility consolidated reports and stated that AMSP educational strategies for hospital personnel were being implemented.

Conclusion: Demonstrating the lack of concordance between the observed AMSP and what it should be could constitute a valuable opportunity to implement strategies that bridge that gap and obtain successful clinical results in patients, bacterial resistance, and costs.