Journal Article

Optimising antibacterial utilisation in Argentine intensive care units: a quality improvement collaborative

Jorro-Baron, Facundo, Guglielmino, Marina, Orlandi, Cristina, Roberti, Javier, Izzo, Gabriela, Balasini, Carina, Cunto, Eleonora, Cornistein, Wanda, Vitar, Emilse, Suarez-Anzorena, Inés, Gibbons, Luz, Ana Paula Rodriguez, Lescano, Marianela, Rivet, Mariano, Rodriguez, Viviana Monica, Pablo Rodrigo Jorge Corral, Perre, Fernando, Rodriguez, Viviana, Villegas, Paula Romina, Cabana, Laura, Ratto, Maria Elena, Meregalli, Claudia, Arias-Lopez, Pilar, García-Elorrio, Ezequiel, Loudet, Cecilia Inés, Becerra, Jacqueline Vilca

2025

Overview

BackgroundThere is limited evidence from antimicrobial stewardship programmes in less-resourced settings. This study aimed to improve the quality of antibacterial prescriptions by mitigating overuse and promoting the use of narrow-spectrum agents in intensive care units (ICUs) in a middle-income country.MethodsWe established a quality improvement collaborative (QIC) model involving nine Argentine ICUs over 11 months with a 16-week baseline period (BP) and a 32-week implementation period (IP). Our intervention package included audits and feedback on antibacterial use, facility-specific treatment guidelines, antibacterial timeouts, pharmacy-based interventions and education. The intervention was delivered in two learning sessions with three action periods along with coaching support and basic quality improvement training.ResultsWe included 912 patients, 357 in BP and 555 in IP. The latter had higher APACHE II (17 (95% CI: 12 to 21) vs 15 (95% CI: 11 to 20), p=0.036), SOFA scores (6 (95% CI: 4 to 9) vs 5 (95% CI: 3 to 8), p=0.006), renal failure (41.6% vs 33.1%, p=0.009), sepsis (36.1% vs 31.6%, p<0.001) and septic shock (40.0% vs 33.8%, p<0.001). The days of antibacterial therapy (DOT) were similar between the groups (change in the slope from BP to IP 28.1 (95% CI: −17.4 to 73.5), p=0.2405). There were no differences in the antibacterial defined daily dose (DDD) between the groups (change in the slope from BP to IP 43.9, (95% CI: −12.3 to 100.0), p=0.1413).The rate of antibacterial de-escalation based on microbiological culture was higher during the IP (62.0% vs 45.3%, p<0.001).The infection prevention control (IPC) assessment framework was increased in eight ICUs.ConclusionImplementing an antimicrobial stewardship program in ICUs in a middle-income country via a QIC demonstrated success in improving antibacterial de-escalation based on microbiological culture results, but not on DOT or DDD. In addition, eight out of nine ICUs improved their IPC Assessment Framework Score.

• Publisher: BMJ Publishing Group LTD
• Subject: Antibiotics / Antimicrobial agents / Collaboration / Critical care / Disease prevention / Drug dosages / Drug stores / Hospital costs / Hospitals / Industrialized nations / Infections / Infectious diseases / Intensive care / Intervention / Microbiological culture / Mortality / Multidrug resistant organisms / Patients / Public sector / Quality improvement / Software