The implementation of antimicrobial stewardship program is one of the basis for the control of multidrug-resistant bacteria (MDR) and the reduction of unnecessary costs, especially in public hospitals. The use of a multimodal strategy is fundamental to the success of a stewardship program.
This is an analysis of antimicrobial consumption in intensive care unit (ICU) of a public hospital in São Paulo, Brazil, before and after the implementation of the antibiotic stewardship program. In the pre-intervention period - January / 2014 to December / 2015 - the rational use of antimicrobials was based only on post-prescription authorization by the infectious diseases doctor. Since January 2016 was established an antibiotic stewardship program based on authorization of antimicrobial use, implementation of an empirical antibiotic protocol according to institutional microbiological profile, measurement of adherence to the protocol and feedback to the leadership, pharmaceutical intervention, educational measures for medical staff and leadership engagement to the program. We compared consumption in DDD per 1,000 patient-days (1000 / pd) and mean cost with antimicrobials in the ICU in US dollars.
The overall antimicrobial consumption reduced from 1032 DDD / 1000pd in the pre-intervention period to 785 DDD / 1000pd post-intervention. Analysis stratified by individual antibiotic was done for the five most commonly used antibiotics. A reduction of 51% consumption for meropenem, 41% for colistin and 41% for vancomycin was observed. Antibiotic costs were reduced from a monthly median of US $ 71.176,49 to US $ 43.772,75 between the two periods. No difference in mortality or mean Apache was observed over the period.
The implementation of the antimicrobial stewardship program can lead to a safe reduction in antibiotic use in the ICU, with significant reduction of costs that can be reapplied in the patient care. Further analyzes are needed to assess the impact on clinical patient outcomes.
F. Piastrelli Sr.,
K. Borges, None
F. Rodrigues, None
C. Borba, None
J. G. Fernandez, None
C. Lima, None