Bacterial resistance is a global public health challenge, requiring the development of effective control strategies. In 2021, an antimicrobial stewardship team was established at our institution to promote rational use through prescription review, evidence-based protocols, training, and indicator monitoring. In April 2024, a significant increase in ceftazidime+avibactam consumption was observed, a high-cost antimicrobial reserved for severe infections caused by carbapenem-resistant Enterobacterales. Therefore, the prescription audit process was revised, implementing prospective double checking. Institutional protocol review and implementation of prospective double checking of ceftazidime+avibactam prescriptions, with the first check performed by the Hospital Infection Control Committee and the second by the antimicrobial stewardship team. Prescription monitoring was carried out using an electronic tool, and the following parameters were evaluated: indication adequacy, treatment duration, antimicrobial consumption, and cost. In addition, immunochromatographic tests for rapid detection of bacterial resistance mechanisms, already implemented, had their indications expanded, optimizing microbiological result acquisition and antimicrobial use. In the pre-intervention period (January to April 2024), 41 patients were treated, totaling 948 vials (mean of 23 vials per treatment), with a total direct cost of R 757, 452. 00 (mean of R 18, 474. 44 per treatment). Consumption indicators were DOT of 6. 54 and DDD of 4. 91 per 1, 000 patient-days. During the intervention period (May to August 2024), 28 patients were treated, with reduced consumption of 476 vials (mean of 17 vials per treatment) and total direct cost of R 380, 324. 00 (mean of R 13, 583. 00 per treatment). DOT and DDD indicators also decreased by 49% and 52%, to 3. 31 and 2. 35, respectively. Implementation of this strategy promoted reduced consumption, especially through optimization of treatment duration. This intervention contributed to compliance with institutional protocols, possible reduction of selective pressure on microorganisms, and optimization of financial resources, demonstrating its effectiveness in antimicrobial stewardship in a hospital environment.
Romano et al. (Sun,) studied this question.