Antimicrobial Stewardship Programs in Latin America and the Caribbean: A Story of Perseverance, Challenges, and Goals

Autores organización

• 

  Natalia Restrepo Arbelaez

  Autor

• 

  Juan Carlos Garcia Betancur

  Autor

• 

  Christian Jose Pallares Gutierrez

  Autor

• 

  Maria Virginia Villegas Botero

  Autor

Grupos de investigación

• Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria RAEH

  

  Investigador

  Maria Virginia Villegas Botero

Resumen

Antimicrobial resistance is one of the major global health threats. Antimicrobial stewardship (AMS) has been set as a priority within international action plans to combat this issue. The region of Latin America and the Caribbean are recognized for their high antimicrobial resistance rates; nevertheless, a low number of studies describing implemented interventions for this topic have been published. This review aims to provide an overview of the status of AMS in our region, focusing on the main progress achieved and describing the different published efforts made by countries towards the implementation of antimicrobial stewardship programs (ASP). Common areas of intervention included were (a) education approaches, (b) antimicrobial guideline implementation and monitoring, (c) diagnostic stewardship, (d) technological tools: electronic clinical decision support systems in AMS, (e) pharmacy-driven protocols and collaborative practice agreements, and (f) economic impact. The search demonstrated the varied interventions implemented in diverse healthcare settings; the results accentuate their influence on antimicrobial consumption, antimicrobial resistance, clinical outcomes, and direct economic impact. The integration of multiple strategies within each hospital was highlighted as an essential key to ASP success. Even though the literature found demonstrated clear progress, there is still a special need for strengthening leadership from the top down, defining goals based on needs, and gaining support through policy and financing in LAC. © 2023 by the authors.

Keywords

• amikacin; ampicillin; azithromycin; aztreonam; carbapenem; cefepime; cefotaxime; ceftazidime; ceftriaxone; cephalosporin; clindamycin; colistin; daptomycin; ertapenem; extended spectrum beta lactamase; fosfomycin; gentamicin; imipenem; levofloxacin; meropenem; nitrofurantoin; piperacillin plus tazobactam; quinolone derivative; sultamicillin; vancomycin; antimicrobial stewardship; bacteremia; biofeedback; Caribbean; clinical audit; clinical decision support system; clinical outcome; cost benefit analysis; cost effectiveness analysis; decision support system; economic development; education; electronic health record; Enterobacter cloacae; Escherichia coli; financial management; global health; health care cost; health care delivery; health care personnel; health care planning; high income country; hospital cost; hospital mortality; hospital readmission; hospitalization; human; intervention study; leadership; length of stay; medical student; multidrug resistant tuberculosis; outcome assess