1555. Clinical Impact of Antimicrobial Stewardship Programs in Colombian Acute Care Hospitals
Session: Poster Abstract Session: Stewardship: Improving Outcomes
Friday, October 6, 2017
Room: Poster Hall CD
  • Background: Inappropriate use of antimicrobials contributes to antimicrobial resistance, which increases hospital length of stay, mortality and health care costs. Antimicrobial Stewardship Programs (ASP) are coordinated quality-improvement efforts to promote the judicious and effective use of antimicrobials to optimize clinical outcomes while minimizing adverse effects. The present study was designed to determine the clinical improvement of patients with healthcare associated infections (HAI) using antimicrobial stewardship policies in Colombian acute care hospitals.

    Methods: We conducted a quasi-experimental study between January 2007 and December 2014 in four acute care hospitals in two Colombian cities. The study variables were evaluated two years before and two years after ASP implementation. Adult patients with HAI episodes in intensive care units or general wards were included. Clinical and economic patient outcomes were compared between groups. Data was analyzed using descriptive and inferential statistics.

    Results: Nine hundred patients with bacterial HAIs were hospitalized in four institutions. The cohort treated before the implementation of ASPs consisted of 471 patients. The cohort treated after ASP implementation consisted of 429 patients. The median age was 62; 70% of patients had at least one comorbidity. Urinary infection was the most common infection (28%), followed by bloodstream infections (26%). After the ASP was implemented, the rate of adherence to empiric treatment clinical guidelines increased from 9% to 45%, while the rate of de-escalating increased from 8% to 92%. Multivariate analysis showed that patients receiving treatment under ASP experienced 10 times clinical improvement compared to patients not treated under ASP. Septic shock after targeted therapy was observed as an independent risk for lack of clinical improvement. Compared to the pre-ASP cohort, the post-ASP cohort experienced a shorter length of stay (10.8 vs. 14 days) and lower total infection cost ($3,307 USD vs. $4,655 USD, p<0.001).

    Conclusion: The use of ASPs results in substantial clinical improvement in patients and contributes to fewer infection complication, shorter length of stay, and decreased costs associated with treating patients.

    Cristhian Hernández-Gómez, MSc1,2, Christian Pallares, MD, MSc1,2, Sergio Reyes, MD1, Max Feinstein, BA1,3, Sergio Gutiérrez, Bac1, Soraya Salcedo, MD, MSc4, Ernesto Martínez, MD5, David Aragon, MD6, Sara Cobo, MD7 and Maria Virginia Villegas, MD, MSc, FIDSA1,2, (1)Bacterial Resistance and Hospital Epidemiology, International Center for Medical Research and Training CIDEIM, Cali, Colombia, (2)Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia, (3)Case Western Reserve University, Cleveland, OH, (4)Clínica General del Norte, Barranquilla, Colombia, (5)Hospital Universitario del Valle, Cali, Colombia, (6)Centro Médico Imbanaco, Cali, Colombia, (7)DIME Clínica Neurocardiovascular, Cali, Colombia


    C. Hernández-Gómez, Merck Sharp & Dohme: Consultant , Consulting fee
    Pfizer: Consultant , Consulting fee

    C. Pallares, Merck Sharp & Dohme, Pfizer: Consultant , Consulting fee

    S. Reyes, None

    M. Feinstein, None

    S. Gutiérrez, None

    S. Salcedo, None

    E. Martínez, None

    D. Aragon, None

    S. Cobo, None

    M. V. Villegas, Merck Sharp & Dohme: Consultant , Consulting fee and Research support
    Pfizer: Consultant , Consulting fee and Research support

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.